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Retrograde hot-shot cardioplegia in patients with left ventricular hypertrophy undergoing aortic valve replacement

Raimondo Ascione1, Saadeh M Suleiman, Gianni D Angelini

  • 1Bristol Heart Institute, University of Bristol, Bristol, United Kingdom. r.ascionen@bristol.ac.uk

The Annals of Thoracic Surgery
|January 29, 2008
PubMed

Insights

Adding a warm-blood hot-shot reperfusion to cold-blood cardioplegia did not improve myocardial protection in patients undergoing aortic valve replacement. The technique showed a potential benefit for reducing ischemic stress in the right ventricle.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardioplegia

Background:

  • Cold-blood cardioplegia with warm-blood hot-shot reperfusion may reduce myocardial injury during coronary surgery.
  • Its effectiveness in patients with left ventricular hypertrophy due to aortic stenosis is not well-established.

Purpose of the Study:

  • To evaluate the efficacy of adding a retrograde warm-blood hot-shot to antegrade cold-blood cardioplegia in preventing myocardial injury.
  • To assess myocardial protection in patients with left ventricular hypertrophy undergoing aortic valve replacement.

Main Methods:

  • Prospective randomized trial of 36 patients undergoing aortic valve replacement.
  • Comparison of cold-blood cardioplegia alone versus cold-blood cardioplegia with retrograde hot-shot.
  • Assessment of myocardial adenosine triphosphate and lactate levels, and troponin I release.

Main Results:

  • No significant difference in myocardial adenosine triphosphate or lactate levels post-reperfusion between groups.
  • A trend towards decreased adenosine triphosphate in the cold-blood cardioplegia group, significant in the right ventricle.
  • Elevated troponin I in both groups, not indicative of myocardial infarction.

Conclusions:

  • Terminal retrograde hot-shot reperfusion offers no additional benefit over antegrade cold-blood cardioplegia for myocardial protection in this patient group.
  • A potential benefit for reducing right ventricular ischemic stress was observed.
  • No significant difference in clinical outcomes was noted between the two groups.
Abstract

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