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[Myocardial protection during aortic valve replacement: effectiveness of continuous warm blood cardioplegia]
H Nagaoka1, R Innami, K Hirooka
1Department of Cardiovascular Thoracic Surgery, Tsuchiura Kyodo General Hospital, Japan.
Insights
Continuous warm blood cardioplegia (CWBC) offers superior myocardial protection during aortic valve replacement (AVR) compared to intermittent cold GIK cardioplegia (ICGC). CWBC significantly improved heart function and preserved aerobic metabolism, leading to better patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiothoracic Anesthesia
- Cardiac Physiology
Background:
- Aortic valve replacement (AVR) requires effective myocardial protection strategies.
- Intermittent cold GIK cardioplegia (ICGC) is a common method, but its efficacy is debated.
- Continuous warm blood cardioplegia (CWBC) presents an alternative approach.
Purpose of the Study:
- To compare the effectiveness of CWBC versus ICGC for myocardial protection during AVR.
- To evaluate the impact of different cardioplegia strategies on early postoperative cardiac function.
- To assess myocardial metabolism during aortic cross-clamping.
Main Methods:
- A comparative study involving 32 patients undergoing AVR.
- 16 patients received CWBC, while 16 patients received ICGC.
- Assessment of spontaneous heart beat recovery, ventricular stroke work indices, and myocardial oxygen/lactate extraction rates.
Main Results:
- No operative or hospital deaths in either group.
- Spontaneous heart beat recovery was significantly higher in the CWBC group (87.5%) compared to ICGC (25%).
- Left and right ventricular stroke work indices significantly increased postoperatively in the CWBC group, unlike the ICGC group. Myocardial oxygen and lactate extraction remained normal in the CWBC group.
Conclusions:
- Continuous warm blood cardioplegia (CWBC) demonstrates superior myocardial preservation compared to intermittent cold GIK cardioplegia (ICGC) during AVR.
- CWBC facilitates better recovery of cardiac function and maintains aerobic myocardial metabolism.
- CWBC is recommended as an effective myocardial protection strategy in AVR procedures.
Abstract:
Effectiveness of continuous warm blood cardioplegia (CWBC) during aortic valve replacement (AVR) was studied by comparing with intermittent cold GIK cardioplegia (ICGC) in 32 patients who underwent AVR using CWBC in 16 and ICGC in the other 16 patients. There was no operative nor hospital death in this series. In CWBC group, spontaneous recovery of the heart beat following aortic declamping was seen in 14 of 16 patients (87.5%), in contrast only in 4 of 16 (25%) in ICGC group. During the early postoperative period, left ventricular stroke work index (g.m/beat/m2) significantly increased from 41.0 +/- 14.4 to 55.9 +/- 8.0 (p < 0.001) in CWBC group, whereas no significant increase was found in ICGC group. Right ventricular stroke work index significantly increased only in CWBC group as well. In CWBC group, myocardial oxygen and lactate extraction rates were maintained within normal range during aortic cross-clamping, suggesting satisfactory myocardial preservation with an aerobic metabolism. In conclusion, CWBC is superior to ICGC as a myocardial protection during AVR.