Related Experiment Videos
A randomized comparison of crystalloid and blood-containing cardioplegic solutions in 60 patients
Insights
Adding blood to cardioplegic solutions did not improve myocardial preservation in patients undergoing coronary revascularization. Despite higher oxygen content, blood-added solutions showed no significant benefits in metabolic markers or cardiac function compared to crystalloid solutions.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Myocardial preservation during cardiac surgery is critical.
- Cardioplegic solutions are used to protect the heart muscle.
- The optimal composition of cardioplegic solutions is continuously investigated.
Purpose of the Study:
- To evaluate the impact of adding blood to crystalloid cardioplegic solutions on myocardial preservation.
- To compare metabolic, damage, and functional markers between blood-added and crystalloid cardioplegic solutions.
Main Methods:
- A randomized prospective study involving 60 patients undergoing coronary revascularization.
- Comparison of crystalloid potassium cardioplegic solution (Group C) versus blood-added potassium cardioplegic solution (Group B).
- Assessment of myocardial metabolism, creatine kinase-MB (CK-MB) levels, and cardiac performance.
Main Results:
- Blood-added solutions had higher oxygen content, lower pH, and increased potassium, calcium, sodium, and glucose.
- A trend towards greater initial oxygen uptake was observed in the blood-added group.
- No significant differences in metabolite release, oxygen extraction, glucose/lactate uptake, CK-MB release, or cardiac function recovery were found between groups.
Conclusions:
- Adding blood to cardioplegic solutions provides more oxygen but does not demonstrably improve myocardial preservation.
- Current study conditions do not support the routine use of blood-added cardioplegic solutions for enhanced myocardial protection.
Abstract:
To determine whether adding blood to a cardioplegic solution affects myocardial preservation, a randomized prospective study was carried out in 60 patients undergoing coronary revascularization to compare the effects of crystalloid potassium cardioplegics (group C) and potassium cardioplegic solutions to which blood has been added (group B) on markers of myocardial metabolism (lactate, inorganic phosphate, base deficit release, glucose and lactate uptake, oxygen extraction), myocardial damage (creatine kinase [CK]-MB levels), and cardiac performance (cardiac index and left atrial pressure). The solution with added blood had a significantly (p less than .05) greater oxygen content, a lower pH, and higher concentrations of potassium, calcium, sodium, and glucose. In group B patients there was a suggestion (p less than .06) of greater uptake of oxygen during the beginning of the initial cardioplegic infusion. During reperfusion there was no evidence of differential release of the metabolites of anaerobiosis and myocardial oxygen extraction and glucose and lactate uptake were similarly depressed in both groups. Likewise, CK-MB release after bypass was the same in both groups. Prompt, adequate functional recovery of cardiac index and left atrial pressure was observed in both groups. It was concluded that although there may be more oxygen available from the blood-containing solution during early infusion, there is no evidence that under the conditions of this investigation adding blood to cardioplegic solution improves myocardial preservation.