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Ultrastructural study of the myocardium using cardioplegic crystalloid solution with and without procaine in patients
Luiz Henrique Dussin1, Leandro de Moura, Marcelo Curcio Gib
1Hospital de Clínicas de Porto Alegre, UFRGS. dussin@ig.com.br
Insights
Adding procaine to cardioplegic solution did not improve myocardial ultrastructure during aortic valve replacement. However, procaine significantly increased the spontaneous return to sinus rhythm post-surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Myocardial protection during cardiac surgery is crucial for patient outcomes.
- Crystalloid cardioplegic solutions are standard for preserving the heart muscle during ischemic arrest.
- The potential benefits of additives like procaine in cardioplegia require further investigation.
Purpose of the Study:
- To evaluate if procaine in crystalloid cardioplegic solution enhances myocardial protection at the ultrastructural level.
- To compare the effectiveness of cardioplegia with and without procaine in patients undergoing aortic valve replacement.
Main Methods:
- Eighteen patients undergoing aortic valve replacement were randomized into two groups: one receiving cardioplegia without procaine (Group A) and one with procaine (Group B).
- Myocardial biopsies were obtained before ischemia, at the end of ischemia, and 15 minutes after reperfusion.
- Ultrastructural analysis and creatine kinase-MB (CK-MB) levels were compared between groups.
Main Results:
- No statistically significant difference in ultrastructural myocardial preservation was observed between the procaine and non-procaine groups.
- CK-MB levels were similar in both groups, indicating comparable levels of myocardial damage.
- A significantly higher rate of spontaneous return to sinus rhythm was noted in the procaine group (70%) compared to the control group (12.5%).
Conclusions:
- Procaine added to crystalloid cardioplegic solution did not provide additional myocardial preservation at the ultrastructural level.
- Both cardioplegic solutions demonstrated equal efficacy in preserving myocardial tissue.
- Procaine significantly improved the likelihood of spontaneous return to sinus rhythm after aortic declamping.
Objective:
The aim of this study was to assess whether the presence of procaine in crystalloid cardioplegic solution increases myocardial protection at the ultra structural level.
Methods:
Eighteen patients that underwent aortic valve replacement in the Hospital de Clínicas de Porto Alegre over a 10-month period were studied. They were randomly allocated into two groups: group A--eight patients receiving cardioplegia without procaine; group B--ten patients receiving cardioplegia with procaine. Myocardial biopsies were performed in three different periods: 1st--before ischemic arrest, 2nd--at the end of ischemic arrest, and 3rd--15 minutes after reperfusion.
Results:
The ultra structural analysis comparing the groups in the three moments did not show any statistically significant difference. The mean score in group A at moment I, II and III was 0.1 +/- 0.2; 0.4 +/- 0.3; 0.4 +/- 0.4, and group B 0.2 +/- 0.2; 0.4 +/- 0.3; 0.7 +/- 0.2. Comparative analysis of CK-MB was similar. The spontaneous return to sinus rhythm after aortic declamping in group B occurred in 70% and in group A 12.5% (p=0.024).
Conclusion:
Both cardioplegic solutions tested were equally effective in myocardial preservation, and we could not demonstrate at the ultrastructural level any benefit when procaine was added. The spontaneous return to sinus rhythm after aortic declamping was significantly greater when procaine was added.
