All-Blood (Miniplegia) Versus Dilute Cardioplegia in Experimental Surgical Revascularization of Evolving Infarction

Abstract

Background The advantages of blood cardioplegia include the oxygen-carrying capacity, superior oncotic and buffering properties, and endogenous antioxidants contained in blood. However, the partial dilution of blood in 4:1 (blood:crystalloid) cardioplegic solutions may nullify these advantages and progressively dilute blood during continuous retrograde delivery. This study tested the hypothesis that all-blood (66:1) cardioplegia provides superior myocardial protection compared with dilute (4:1) cardioplegia delivered in a continuous retrograde modality during surgical reperfusion of evolving myocardial infarction. Methods and Results After 60 minutes of left anterior descending coronary artery (LAD) occlusion, anesthetized canines were placed on cardiopulmonary bypass and randomized to either all-blood cardioplegia (AB group) or dilute blood cardioplegia (Dil group). After cross clamping, arrest was induced with 5 minutes of tepid (30°C) antegrade potassium all-blood or dilute blood cardioplegia and maintained with tepid retrograde coronary sinus cardioplegia for a total of 1 hour. The LAD was released after 30 minutes of arrest, simulating revascularization. The cardioplegia hematocrit for the Dil group was lower than that for the AB group (7±1% versus 12±2%, P <0.05); at the end of bypass, systemic hematocrit was lower in the Dil group than in the Ab group (15±1% versus 20±1%, P <0.05). Infarct size (triphenyltetrazolium chloride staining) was comparable between the AB and Dil groups (29.6±2.9% versus 30.3±3.9% of area at risk), and there was no difference in area-at-risk myocardium systolic shortening (by sonomicrometry, −0.3±1% versus −0.4±1%). Tissue edema after bypass tended to be greater in the Dil group compared with the AB group in the heart (82±0% versus 81±1%), lung (79±1% versus 78±1%), liver (75±1% versus 74±0%), and skeletal muscle (76±1% versus 73±2%) and was significantly greater in the duodenum (80±1% versus 79±1%, P <0.05) and kidney (82±1% versus 79±1%, P <0.05). Postexperimental endothelial function (relaxation of acetylcholine) was impaired in LADs of the AB group versus the Dil group (59±6% versus 77±5%, P <0.05). Conclusions Both all-blood cardioplegia and dilute cardioplegia have disadvantages, but these do not have an impact on the pathogenesis of infarct size or recovery of regional contractile function.

Whole Blood del Nido versus Cold Blood Microplegia in Adult Cardiac Surgery: A Propensity-Matched Analysis

“…18 In addition, it has been proposed that microplegia may increase endothelial injury, leading to decreased postoperative cardiac function. 19 However, in our analysis, BDN had excellent clinical measures of postoperative myocardial recovery despite cooling to 6°C, including comparable incidence of postoperative atrial fibrillation, cardiac arrest, and ventricular assist device. Risk of stroke was low, as well as the risk of hemodialysis and prolonged length of stay.…”