Initial large-dose administration of modified St. Thomas' solution

Area of Science:

• Cardiovascular Surgery
• Cardiac Anesthesia
• Cardioplegia Solutions

Background:

• Modified St. Thomas' Hospital cardioplegic solution was developed for enhanced myocardial protection and smoother intraoperative procedures.
• Conventional glucose-insulin-potassium cardioplegia is a standard method for myocardial protection during cardiac surgery.

Purpose of the Study:

• To evaluate the efficacy of a modified cardioplegia technique compared to conventional methods in isolated aortic valve replacement.
• To assess the impact of the modified cardioplegia on myocardial protection and intraoperative conditions.

Main Methods:

• A randomized trial involving 90 patients undergoing isolated aortic valve replacement.
• Group S (45 patients) received a modified St. Thomas' Hospital cardioplegic solution with added potassium and a specific initial dose.
• Group G (45 patients) received conventional glucose-insulin-potassium cardioplegia.

Main Results:

• The modified cardioplegia group (S) demonstrated significantly shorter mean reperfusion times after aortic declamping (16.7 vs. 21.5 min).
• Postoperative maximum creatine kinase-MB levels were significantly lower in group S (25.6 vs. 40.6 IU·L(-1)).
• Multivariate analysis confirmed the association between modified cardioplegia, aortic crossclamp time, creatine kinase-MB levels, and reperfusion time.

Conclusions:

• The modified cardioplegia technique is an acceptable alternative for isolated aortic valve replacement.
• This approach provides a bloodless operative field and reduces the need for repeated cardioplegic administrations.