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Coronary endothelial damage after crystalloid cardioplegia
Insights
Cold blood cardioplegia effectively protects the heart
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardioplegia Research
Background:
- Cardioplegic solutions are used to prevent myocardial damage during ischemic arrest.
- The impact of cardioplegia on the coronary endothelium is not well understood.
Purpose of the Study:
- To investigate the effects of three different cardioplegic solutions on the coronary endothelium.
- To assess myocardial preservation and high-energy compounds in relation to cardioplegia composition.
Main Methods:
- Biochemical assays were used to study myocardial preservation.
- Histological examination of the coronary endothelium was performed.
- Comparison of blood cardioplegia, crystalloid cardioplegia, and albumin-modified crystalloid cardioplegia.
Main Results:
- Blood cardioplegia did not cause coronary endothelial damage.
- Crystalloid cardioplegia led to endothelial cell loss and surface deformity.
- Albumin in crystalloid solution partially preserved endothelial integrity.
- Myocardial high-energy compound preservation was primarily dependent on cooling, not solution composition.
- No correlation was found between high-energy compounds and endothelial changes.
Conclusions:
- Cold blood cardioplegia is favored for preserving both the coronary endothelium and myocardial energy sources during ischemic cardiac arrest.
- Crystalloid cardioplegia poses a risk to the coronary endothelium.
Abstract:
There is considerable clinical experience to suggest that damage to the myocardium during ischaemic arrest can be prevented by cardioplegic solutions. However, very little is known about the effects of these cardioplegic solutions on the coronary endothelium. The effects of three different cardioplegic solutions on the coronary endothelium are reported here. Preservation of the myocardium was studied with biochemical assays. Blood cardioplegia did not damage the coronary endothelium. Crystalloid cardioplegia caused disappearance of the endothelial cells and gross deformity of the flow surface. The addition of albumin to the crystalloid solution preserved most of the endothelial lining. Preservation of the myocardial high energy compounds seemed to be dependent only on the cooling effect of the cardioplegia and not on the composition of the solution. There was no correlation between high energy compounds and endothelial changes. The present study favours the use of cold blood cardioplegia which preserves both the coronary endothelium and the myocardial energy sources during ischaemic cardiac arrest.