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Microcirculatory Response to Blood vs. Crystalloid Cardioplegia During Coronary Artery Bypass Grafting With
Güclü Aykut1, Halim Ulugöl2, Uğur Aksu3
1Department of Intensive Care, Laboratory of Translational Intensive Care, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands.
Insights
Blood cardioplegia better preserves microcirculation during cardiac surgery compared to crystalloid cardioplegia. This approach may reduce systemic inflammation and improve outcomes in patients undergoing coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Microcirculation Research
Background:
- Cardiopulmonary bypass (CPB) can induce systemic inflammatory responses affecting microcirculation.
- Blood cardioplegia is hypothesized to mitigate these CPB-induced effects.
- Understanding microcirculatory changes is crucial for optimizing cardiac surgery outcomes.
Purpose of the Study:
- To compare the efficacy of blood cardioplegia versus crystalloid cardioplegia in preserving microcirculation during coronary artery bypass grafting (CABG) with CPB.
- To investigate the impact of different cardioplegia solutions on sublingual microvascular function.
Main Methods:
- Prospective observational cohort study involving 20 patients undergoing CABG.
- Patients received either crystalloid cardioplegia (n=10) or blood cardioplegia (n=10).
- Sublingual microcirculation was assessed using incident dark-field imaging at five time points from anesthesia induction to CPB discontinuation.
Main Results:
- Both cardioplegia types reduced microcirculatory parameters (total vessel density, perfused vessel density, proportion of perfused vessels) during CPB.
- Blood cardioplegia group (BCG) showed restoration of microcirculatory parameters to baseline levels by CPB discontinuation.
- Crystalloid cardioplegia group (CCG) exhibited persistent reductions in microcirculatory parameters (%ΔTVD: -10.86% vs. 0.08%, p<0.001; %ΔPVD: -12.91% vs. 1.53%, p<0.001; %ΔPPV: -2.35% vs. 1.48%, p<0.01).
Conclusions:
- Blood cardioplegia demonstrates superior preservation of microcirculation compared to crystalloid cardioplegia in CABG patients undergoing CPB.
- This improved microcirculatory function with blood cardioplegia may be linked to attenuated systemic inflammatory responses.
- Further research is warranted to elucidate the specific mechanisms underlying the benefits of blood cardioplegia on microcirculation.
Abstract:
Background: Blood cardioplegia attenuates cardiopulmonary bypass (CPB)-induced systemic inflammatory response in patients undergoing cardiac surgery, which may favorably influence the microvascular system in this cohort. The aim of this study was to investigate whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB. Methods: In this prospective observational cohort study, 20 patients who received crystalloid (n = 10) or blood cardioplegia (n = 10) were analyzed. The microcirculatory measurements were obtained sublingually using incident dark-field imaging at five time points ranging from the induction of anesthesia (T0) to discontinuation of CPB (T5). Results: In the both crystalloid [crystalloid cardioplegia group (CCG)] and blood cardioplegia [blood cardioplegia group (BCG)] groups, perfused vessel density (PVD), total vessel density (TVD), and proportion of perfused vessels (PPV) were reduced after the beginning of CPB. The observed reduction in microcirculatory parameters during CPB was only restored in patients who received blood cardioplegia and increased to baseline levels as demonstrated by the percentage changes from T0 to T5 (%Δ)T0- in all the functional microcirculatory parameters [%ΔTVDT0-(CCG): -10.86 ± 2.323 vs. %ΔTVDT0-(BCG): 0.0804 ± 1.107, p < 0.001; %ΔPVDT0-(CCG): -12.91 ± 2.884 vs. %ΔPVDT0-(BCG): 1.528 ± 1.144, p < 0.001; %ΔPPVT0-(CCG): -2.345 ± 1.049 vs. %ΔPPVT0-(BCG): 1.482 ± 0.576, p < 0.01]. Conclusion: Blood cardioplegia ameliorates CPB-induced microcirculatory alterations better than crystalloid cardioplegia in patients undergoing CABG, which may reflect attenuation of the systemic inflammatory response. Future investigations are needed to identify the underlying mechanisms of the beneficial effects of blood cardioplegia on microcirculation.
