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Carvedilol-Enriched Cold Oxygenated Blood Cardioplegia Improves Left Ventricular Diastolic Function After Weaning
Geir Olav Dahle1, Pirjo-Riitta Salminen2, Christian Arvei Moen3
1Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway;; Department of Clinical Science, University of Bergen, Bergen, Norway;.
Insights
Adding carvedilol to blood cardioplegia improved diastolic cardiac function and reduced oxidative stress in pigs after bypass. This antioxidant agent enhanced myocardial recovery following cardioplegic arrest.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Pharmacology
Background:
- Myocardial protection during cardiac surgery is crucial for patient outcomes.
- Oxygenated blood cardioplegia is a standard method for inducing cardiac arrest.
- Carvedilol possesses antioxidant properties and receptor-blocking activity that may benefit myocardial function.
Purpose of the Study:
- To evaluate the efficacy of adding carvedilol to oxygenated blood cardioplegia.
- To determine if carvedilol improves myocardial function after weaning from cardiopulmonary bypass.
- To assess the impact of carvedilol on myocardial oxidative stress.
Main Methods:
- A randomized controlled study was conducted in a university laboratory setting.
- Twenty anesthetized pigs underwent cardiopulmonary bypass with cold, oxygenated blood cardioplegia containing either carvedilol or a vehicle.
- Cardiac arrest was maintained for 100 minutes, followed by reperfusion and assessment of left ventricular function using pressure-volume loops and strain analysis.
Main Results:
- Carvedilol significantly improved left ventricular diastolic compliance and relaxation.
- Diastolic relaxation constant (τ) and dP/dtmin were significantly improved in the carvedilol group.
- Myocardial oxidative stress, indicated by malondialdehyde levels, was significantly reduced by carvedilol treatment.
- No significant differences were observed in systolic function parameters between the groups.
Conclusions:
- Carvedilol added to blood cardioplegia enhances diastolic cardiac function post-reperfusion.
- Carvedilol effectively reduces myocardial oxidative stress in a porcine model.
- The findings suggest a potential benefit of carvedilol in myocardial protection during cardiac surgery.
Objectives:
To investigate whether adding carvedilol, a nonselective β- and selective α1-receptor blocking agent with antioxidant properties, to oxygenated blood cardioplegia improves myocardial function after weaning from bypass.
Design:
A randomized controlled study.
Setting:
A university laboratory.
Participants:
Twenty anesthetized pigs, Norwegian Landrace.
Interventions:
On cardiopulmonary bypass, cardiac arrest was induced with cold (12°C), oxygenated blood cardioplegia, enriched with carvedilol or vehicle, and repeated every 20 minutes. After 100 minutes, the heart was reperfused and weaned.
Measurements And Main Results:
Left ventricular function was evaluated with pressure-volume loops, local myocardial systolic strain, and strain rate from Speckle tracking analysis and multilayer short-axis tissue Doppler Imaging. In the carvedilol group, the load-independent logarithmic end-diastolic pressure volume relationship, β, decreased from 1 to 3 hours of reperfusion and was low, 0.028±0.004 v 0.042±0.007 (p<0.05) in controls at 3 hours, demonstrating improved left ventricular compliance. The diastolic relaxation constant τ was decreased, 28.9±0.6 ms v 34.6±1.3 ms (pg<0.035), and dP/dtmin was more negative,-1,462±145 mmHg/s v-1,105±105 mmHg/s (pg = 0.024), for carvedilol v control group. The systolic variables, preload recruitable stroke work and end-systolic pressure-volume relationship, did not differ between groups, neither did left ventricular systolic strain and strain rate. Myocardial oxidative stress, measured as tissue levels of malondialdehyde, was reduced by carvedilol, 0.19±0.01 compared to 0.24±0.01 nmol/mg (p = 0.004) in controls.
Conclusions:
Carvedilol added to blood cardioplegia improved diastolic cardiac function and reduced oxidative stress during the first 3 hours after reperfusion in a porcine model, with 100 minutes of cardioplegic arrest.
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