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Published on: December 10, 2020
Experimental Comparison of Esmolol- and Blood-Based Cardioplegia for Long Aortic Clamping Times
Andreas Böning1, Balli Chapugi1, Martina Heep1
1Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany.
Insights
Esmolol crystalloid cardioplegia (ECCP) provides superior hemodynamic recovery and myocardial protection compared to Calafiore blood cardioplegia (Cala) after prolonged ischemia. ECCP better preserves cardiac function and reduces injury markers in rat hearts.
Area of Science:
- Cardiovascular Surgery
- Cardioplegia Research
- Myocardial Protection Strategies
Background:
- Prolonged aortic clamping and extracorporeal circulation times negatively impact cardiac surgery outcomes.
- Optimizing cardioplegia solutions is crucial for minimizing myocardial damage during cardiac procedures.
Purpose of the Study:
- To compare the efficacy of esmolol crystalloid cardioplegia (ECCP) versus Calafiore blood cardioplegia (Cala) in preserving myocardial function and structure.
- To evaluate hemodynamic performance, myocardial metabolism, and ultrastructural integrity following ischemia-reperfusion injury in a rat heart model.
Main Methods:
- Wistar rat hearts were subjected to 120 minutes of ischemia followed by 90 minutes of reperfusion in a Langendorff system.
- Hearts received either ECCP (32°C for 3 minutes) or Cala (36°C for 2 minutes) every 20 minutes.
- Hemodynamic parameters (coronary blood flow, left ventricular developed pressure, ±dp/dt), myocardial metabolism markers (oxygen consumption, lactate, troponin I), and ultrastructure were assessed.
Main Results:
- ECCP demonstrated significantly higher coronary blood flow (85% vs. 42% of baseline) and left ventricular developed pressure (91% vs. 43% of baseline) post-reperfusion compared to Cala.
- Myocardial contraction and relaxation velocities (dLVP/dtmax and dLVP/dtmin) were markedly improved with ECCP.
- Troponin I levels, indicative of myocardial injury, were significantly lower in the ECCP group (442.3 ng/mL vs. 1102.6 ng/mL for Cala).
Conclusions:
- Esmolol crystalloid cardioplegia (ECCP) offers superior hemodynamic recovery and myocardial protection against ischemia/reperfusion injury compared to Calafiore blood cardioplegia (Cala).
- ECCP facilitates better preservation of cardiac function and reduces myocardial damage, even after extended aortic clamping times.
Abstract:
After cardiac surgery, long aortic clamping times and extracorporeal circulation times are associated with worse outcomes. This study compares hemodynamic performance, myocardial metabolism, and ultrastructural preservation in rat hearts after applying esmolol crystalloid cardioplegia (ECCP) or Calafiore blood cardioplegia (Cala).Hearts from 18 Wistar rats were perfused in a Langendorff system. Following 120 minutes of ischemia at 36 °C, hearts received either ECCP at 32 °C for 3 minutes or Cala at 36 °C for 2 minutes every 20 minutes. During 90 minutes of reperfusion, coronary blood flow (CF), left ventricular developed pressure (LVDP), and contraction/relaxation velocities (±dp/dt) were recorded. Myocardial oxygen consumption, lactate production, and troponin I levels were measured. Electron microscopy was used for ultrastructural assessment.Baseline (BL) values of LVDP, CF, and ±dp/dt were similar between the two groups. After 90 minutes of reperfusion, CF was significantly higher in the ECCP group: 85 ± 43% of BL in the ECCP group versus 42 ± 24% of BL in the Cala group (p = 0.002). At the end of reperfusion, hearts exposed to ECCP had higher LVDP (91 ± 40%) values than Cala (43 ± 10%), indicating improved cardiac recovery with ECCP. Myocardial contraction and relaxation were notably better in the ECCP group: dLVP/dtmax was 111 ± 40% versus 59 ± 13% in the Cala group (p = 0.002), and dLVP/dtmin was 88 ± 34% versus 40 ± 7% (p = 0.001). Troponin I levels measured in Cala hearts at the end of reperfusion were higher than in ECCP hearts (Cala 1,102.6 ± 361.3 ng/mL vs. ECCP 442.3 ± 788.4 ng/mL, p = 0.036).In rat hearts, ECCP offers better hemodynamic recovery and protects the myocardium from ischemia/reperfusion-related damage, better than Cala blood cardioplegia, even with aortic clamping times of 120 minutes.
