[Modified substitution of intracellular cations]

Area of Science:

• Cardiovascular Surgery
• Cardiothoracic Anesthesia
• Clinical Nutrition and Metabolism

Background:

• Electrolyte and trace metal balance is crucial for cardiac function, particularly during cardiac surgery.
• Standard electrolyte supplementation may not adequately address intracellular deficiencies.
• Mitral valve replacement (MVR) surgery presents unique challenges for maintaining optimal intracellular ion levels.

Purpose of the Study:

• To evaluate the impact of different electrolyte and trace metal supplementation strategies on intracellular uptake in patients undergoing MVR.
• To compare the efficacy of potassium chloride, potassium aspartate, and a balanced aspartate-based solution on tissue ion levels.

Main Methods:

• Randomized controlled trial with 75 patients undergoing MVR, divided into three groups (n=25 each).
• Group A received potassium and sodium chloride; Group B received potassium aspartate; Group C received a balanced aspartate-based solution (Inzolen).
• Papillary muscle tissue was analyzed for sodium, potassium, magnesium, zinc, and copper (Na, K, Mg, Zn, Cu) content via atomic absorption.

Main Results:

• All groups showed subnormal sodium levels in papillary tissue, irrespective of treatment.
• Potassium levels were significantly lower in the potassium chloride group (Group A) compared to aspartate groups (B and C).
• Tissue levels of magnesium, zinc, and copper were also lower in Group A; no significant difference was observed between Group B and Group C.

Conclusions:

• Aspartate as an anion appears to enhance the utilization of intracellular cations, including potassium, magnesium, zinc, and copper.
• Effective treatment of electrolyte and trace metal deficiencies is vital in cardiac surgery.
• Aspartate-based solutions may offer superior intracellular delivery of essential minerals compared to traditional chloride-based regimens.