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Myocardial protection with Hamburg oxygenated crystalloid cardioplegic solution for multiple coronary bypass and
1Department of Cardiovascular Surgery, Hôpital Cardiologique, Bron, France.
Insights
The Hamburg oxygenated crystalloid cardioplegic solution effectively protected heart muscle during surgery. It preserved vital energy compounds and led to excellent early recovery in coronary artery bypass grafting and valve replacement patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardioplegia Research
Background:
- Myocardial protection during cardiac surgery is crucial for patient outcomes.
- Crystalloid cardioplegia solutions are widely used, but their efficacy can vary.
- Optimizing myocardial energy metabolism during ischemia is a key surgical goal.
Purpose of the Study:
- To evaluate the efficacy of the Hamburg oxygenated crystalloid cardioplegic solution for myocardial protection.
- To assess the impact of this solution on myocardial energy metabolites (ATP and CP).
- To analyze early postischemic myocardial function and clinical outcomes in cardiac surgery patients.
Main Methods:
- Prospective metabolic study in 30 coronary artery bypass grafting (CABG) patients measuring myocardial adenosine triphosphate (ATP) and creatine phosphate (CP) levels.
- Evaluation of early postischemic myocardial function in 228 patients (48 multiple valve replacement - MUVR, 180 CABG) using cardiac index.
- Assessment of myocardial infarction rates and early postoperative mortality.
Main Results:
- Myocardial ATP levels were preserved at 90% and CP levels recovered to 85% of preischemic values after reperfusion.
- Spontaneous myocardial defibrillation occurred in over 90% of patients.
- Significant improvements in cardiac index were observed post-surgery; myocardial infarction was 3% in CABG patients, and early mortality was low (0.5% for CABG, 6.2% for MUVR).
Conclusions:
- The Hamburg oxygenated cardioplegia solution effectively preserves high-energy phosphate compounds, preventing significant ischemic injury.
- The solution demonstrates excellent short-term clinical results, including good myocardial function and low complication rates.
- This cardioplegic strategy offers a promising approach for myocardial protection in cardiac surgery.
Abstract:
We evaluated myocardial protection with Hamburg oxygenated crystalloid cardioplegic solution in a double study. Part I was a prospective metabolic study, measuring myocardial adenosine triphosphate (ATP) and creatine phosphate (CP) contents before and after ischemia in 30 coronary bypass (CABG) patients. During ischemia, CP levels decreased significantly, whereas ATP did not. After 10 minute of reperfusion, mean ATP contents were 90% of preischemic values and CP levels increased to 85% of preischemic values. Spontaneous myocardial defibrillation was seen in 93.3% of patients. Part II included evaluation of early postischemic myocardial function in 228 patients, 48 with multiple valve replacement (MUVR) and 180 with CABG. Spontaneous myocardial defibrillation was seen in 90.3%. Cardiac index, measured before and 1 and 12 hours after surgery, increased significantly in the postischemic period (from 1.95 +/- 0.9 to 2.5 +/- 0.7 l/min m2 in MUVR, p 0.04; from 2.2 +/- 0.6 to 2.7 +/- 0.7 l/min/m2 in CABG, p 0.01). Myocardial infarction frequency was 3% among CABG patients, and unrelated to the number of distal anastomosis or to aortic cross-clamp time. Early postoperative mortality was 6.2% for MUVR and 0.5% for CABG. Thus, oxygenated cardioplegia with Hamburg solution preserves high-energy phosphate compounds and prevents ischemic injury, with excellent short-term clinical results.