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St. Thomas' Hospital cardioplegia: enhanced protection with exogenous creatine phosphate
D J Chambers1, K Haire, N Morley
1Cardiac Surgical Research, Rayne Institute, St. Thomas' Hospital, London, United Kingdom.
Insights
Creatine phosphate (CP) added to cardioplegic solution reduced postoperative arrhythmias and the need for inotropic support in valve replacement patients. This enhanced myocardial protection improved patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biochemistry
Background:
- Creatine phosphate (CP) is known to improve postischemic recovery and reduce arrhythmias experimentally.
- Cardiac surgery patients often experience myocardial damage and arrhythmias postoperatively.
Purpose of the Study:
- To evaluate the efficacy of adding creatine phosphate (CP) to St. Thomas' Hospital cardioplegic solution No. 1 for myocardial protection during valve replacement surgery.
- To assess the impact of CP on postoperative arrhythmias, inotropic support requirements, and myocardial function.
Main Methods:
- A randomized study of 50 patients undergoing valve replacement.
- Patients received either standard cardioplegic solution or the solution plus CP (10 mmol/L).
- Outcomes assessed included electrocardiographic analysis, inotropic drug requirement, myocardial phosphate content, function, and ultrastructure.
Main Results:
- The CP-treated group showed significantly fewer direct-current shocks and lower total joules required.
- Higher incidence of spontaneous sinus rhythm and lower incidence of postoperative arrhythmias were observed in the CP group.
- Fewer patients in the CP group required prolonged inotropic administration, with a greater response to support when needed.
Conclusions:
- St. Thomas' Hospital cardioplegic solution No. 1 supplemented with CP enhances myocardial protection.
- CP confers direct patient benefits by reducing postoperative arrhythmias and the need for prolonged inotropic support.
- CP is a valuable adjunct in cardioplegia for cardiac valve replacement surgery.
Background:
Experimentally, creatine phosphate (CP) improves postischemic recovery of function and reduces postischemic arrhythmias.
Methods:
We studied 50 patients undergoing valve replacement. They were randomized into either a control group, who received St. Thomas' Hospital cardioplegic solution No. 1, or a CP-treated group, receiving the same cardioplegic solution plus CP (10 mmol/L). There were no preoperative clinical differences between groups. Assessment was by electrocardiographic analysis, inotropic drug requirement, quantitative birefringence, myocardial high-energy phosphate content, function, and semiquantitative ultrastructural assessment.
Results:
Direct-current shocks were reduced in the CP-treated group (0.88 +/- 0.15) compared with the control group (1.40 +/- 0.14; p < 0.02), as was the total number of joules (22.0 +/- 3.5 versus 34.4 +/- 3.7, respectively; p <0.02). The incidence of spontaneous sinus rhythm was higher in the CP-treated group (40% versus 8%; p < 0.05) and the incidence of postoperative arrhythmias, lower (8% versus 32%; p < 0.05). Prolonged inotropic administration (12 hours or longer) occurred in fewer patients in the CP-treated group (4% versus 28%; p < 0.05). Response to inotropic support (in the subset of patients requiring this treatment) was significantly greater in the CP-treated group than in the control group. There were no differences in recovery of function, birefringence changes, myocardial high-energy phosphate content, or ultrastructure between groups.
Conclusions:
St. Thomas' Hospital cardioplegic solution No. 1 plus CP enhanced myocardial protection and conferred a direct benefit to the patient by reducing postoperative arrhythmias and need of prolonged inotropic support.