[Aortic valve replacement in cardioplegic heart arrest]

Area of Science:

• Cardiology
• Cardiac Surgery
• Cardioplegia

Context:

• Aortic valve replacement (AVR) procedures historically utilized cold ischaemic cardiac arrest for myocardial preservation.
• The introduction of the St. Thomas cardioplegic solution in 1980 marked a shift in cardiac surgical practice.
• This study evaluates the clinical outcomes associated with the St. Thomas cardioplegic solution in AVR.

Purpose:

• To assess the efficacy and safety of the St. Thomas cardioplegic solution for myocardial preservation during aortic valve replacement.
• To compare the outcomes of AVR using cardioplegia versus cold ischaemic arrest.
• To analyze intraoperative and postoperative complications and biochemical markers.

Summary:

• In 62 aortic valve replacements performed since the adoption of the St. Thomas cardioplegic solution, no hospital mortality was observed.
• Fewer intraoperative and postoperative complications were noted with cardioplegic perfusion compared to previous cold ischaemic arrest methods.
• While most cardioplegic effluent entered extracorporeal circulation, intraoperative serum potassium levels remained stable. Postoperative serum creatine phosphokinase levels were significantly lower after cardioplegia.

Impact:

• The St. Thomas cardioplegic solution has demonstrated a significant improvement in patient outcomes for aortic valve replacement surgery.
• This myocardial preservation strategy reduces surgical risk, leading to enhanced patient recovery and fewer complications.
• The findings support the widespread adoption of cardioplegic solutions in cardiac surgery for improved patient safety and surgical success.