Comparison of the different cardioplegic strategies in cardiac valves surgery: who wins the “arm-wrestling”?

Castaldo, Giuseppe; Giordano, Raffaele; Palma, Gaetano Di

doi:10.21037/jtd.2018.01.133

Cited by 15 publications

(12 citation statements)

References 21 publications

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“…The notion that the best cardioplegic solution for myocardial protection is yet to be found has been supported in several reviews. 25,26 It can be concluded that current cardioplegic solutions are equally effective at protecting the myocardium during MIVS. For all practical purposes, the use of BC or CC comes down to operator preference.…”

Section: Discussionmentioning

confidence: 99%

In search of optimal cardioplegia for minimally invasive valve surgery

2021

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Cardioplegic solutions are used in cardiac surgery to achieve controlled cardiac arrest during operations, making surgery safer. Cardioplegia can either be blood or crystalloid based, with perceived pros and cons of each type. Whilst it is known that cardioplegia causes cardiac arrest, there is debate over which cardioplegic solution provides the highest degree of myocardial protection during arrest. Myocardial damage is measured post-operatively by biomarkers such as serum TnT, TnI or CK-MB. It is known that the outcomes of minimally invasive valve surgery are comparable to full sternotomy valve operations. Despite there being a wide diversity in use of different cardioplegic solutions across the world, this comprehensive literature review found no superiority of one cardioplegic solution over the other for myocardial protection during minimally invasive valve procedures.

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Section: Discussionmentioning

confidence: 99%

In search of optimal cardioplegia for minimally invasive valve surgery

2021

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“…In contrast, the Custodiol solution is a form of long acting, single dose cardioplegia consisting primarily of potassium chloride, sodium chloride, and magnesium sulfate as the chief electrolytes [11]. Additional components of the Custodiol solution include tryptophan (membrane stabilization) and histidine buffer (to maintain pH and buffer against byproducts of anaerobic glycolysis that build up during cardioplegia).…”

Section: Crystalloid Vs Bloodmentioning

confidence: 99%

“…For example, blood can support aerobic respiration and may be able to preserve normal myocardial metabolism during surgery. Therefore, blood cardioplegia may reduce the negative consequences of prolonged ischemia during CPB [11]. However, insufficient evidence exists currently to verify that hypothesis, and so any purported advantages of blood over crystalloid cardioplegia are for the time being mainly speculative.…”

Section: Crystalloid Vs Bloodmentioning

confidence: 99%

Potassium and Cardiac Surgery

Kant¹,

Sellke²,

Feng³

2022

Physiology

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Potassium homeostasis affects cardiac rhythm and contractility, along with vascular reactivity and vascular smooth muscle proliferation. This chapter will focus on potassium dynamics during and after cardiac surgery involving cardioplegic arrest and cardiopulmonary bypass (CPB). Hyperkalemic, hypothermic solutions are frequently used to induce cardioplegic arrest and protect the heart during cardiac surgery involving CPB. Common consequences of hyperkalemic cardioplegic arrest and reperfusion include microvascular dysfunction involving several organ systems and myocardial dysfunction. Immediately after CPB, blood potassium levels often drop precipitously due to a variety of factors, including CPB -induced electrolyte depletion and frequent, long-term administration of insulin during and after surgery. Meanwhile, some patients with pre-existing kidney dysfunction may experience postoperative hyperkalemia following cardioplegia. Any degree of postoperative hyper/hypokalemia significantly elevates the risk of cardiac arrythmias and subsequent myocardial failure. Therefore, proper management of blood potassium levels during and after cardioplegia/CPB is crucial for optimizing patient outcomes following cardiac surgery.

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“…In cardiac surgery, hypothermia combined with cold cardioplegia (Custodiol) also has an important protective effect in complex procedures requiring prolonged aortic cross-clamping, or procedures in which frequent administration of cardioplegia is difficult because of the access used [ 81 ].…”

Section: Future Perspectivesmentioning

confidence: 99%

The Role of Deep Hypothermia in Cardiac Surgery

Gocoł

Hudziak

Bis

et al. 2021

IJERPH

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Hypothermia is defined as a decrease in body core temperature to below 35 °C. In cardiac surgery, four stages of hypothermia are distinguished: mild, moderate, deep, and profound. The organ protection offered by deep hypothermia (DH) enables safe circulatory arrest as a prerequisite to carrying out cardiac surgical intervention. In adult cardiac surgery, DH is mainly used in aortic arch surgery, surgical treatment of pulmonary embolism, and acute type-A aortic dissection interventions. In surgery treating congenital defects, DH is used to assist aortic arch reconstructions, hypoplastic left heart syndrome interventions, and for multi-stage treatment of infants with a single heart ventricle during the neonatal period. However, it should be noted that a safe duration of circulatory arrest in DH for the central nervous system is 30 to 40 min at most and should not be exceeded to prevent severe neurological adverse events. Personalized therapy for the patient and adequate blood temperature monitoring, glycemia, hematocrit, pH, and cerebral oxygenation is a prerequisite and indispensable part of DH.

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Comparison of the different cardioplegic strategies in cardiac valves surgery: who wins the “arm-wrestling”?

Cited by 15 publications

References 21 publications

In search of optimal cardioplegia for minimally invasive valve surgery

In search of optimal cardioplegia for minimally invasive valve surgery

Potassium and Cardiac Surgery

The Role of Deep Hypothermia in Cardiac Surgery

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