Esmolol Added in Repeated, Cold, Oxygenated Blood Cardioplegia Improves Myocardial Function After Cardiopulmonary Bypass

Abstract

Esmolol added to blood cardioplegia preserved systolic cardiac function during the first 3 hours after reperfusion in a porcine model with 100 minutes of cardioplegic arrest.

Carvedilol-Enriched Cold Oxygenated Blood Cardioplegia Improves Left Ventricular Diastolic Function After Weaning From Cardiopulmonary Bypass

“…This was demonstrated in a similar model using the ultra-short-acting beta-blocker esmolol as an additive to the cardioplegic solution. 8 In the present study, no convincing improvement in left ventricular systolic function was demonstrated (Fig 3). More likely, the antioxidant properties of carvedilol caused the enhanced diastolic function.…”

“…This is likely to be the mechanism behind the better-preserved contractile function after CPB demonstrated for esmolol. 8 PRSW, dP/dt max and echo-derived strain rate increased with esmolol treatment. In the present study, a significant difference between groups for dP/dt max 2 hours after declamping was found but no differences in ESPVR or PRSW.…”

“…5,6 In experimental protocols, both pretreatment with the short-acting β-blocker esmolol or addition of esmolol in cold, intermittent, oxygenated blood cardioplegia improves myocardial contractility in the early hours after CPB and cardiac arrest. 7,8 The occurrence of oxidative stress is a major component in both lethal reperfusion injury and in recruitment and activations of neutrophil granulocytes as part of the inflammatory response to CPB. 9 Carvedilol, a non-selective beta-and alpha 1 -receptor blocker with powerful antioxidative properties, is therefore of particular interest as a cardioprotective agent.…”

Novel cardioprotection strategies for the aged heart: evidence from pre‐clinical studies

“…Indeed, arrest with esmolol alone has been shown experimentally to protect from damage induced by cardioplegia and esmolol pre‐treatment improves outcomes in the pig cardiopulmonary bypass model . A more recent study has shown that use of a blood‐based cardioplegic solution supplemented with esmolol improves both pre‐load recruitable stroke work and the cardiac index in a pig bypass model compared to cardioplegia alone (Table ) . Thus, beta‐blockers appear to enhance recovery of function following cardioplegia.…”

“…53 A more recent study has shown that use of a blood-based cardioplegic solution supplemented with esmolol improves both pre-load recruitable stroke work and the cardiac index in a pig bypass model compared to cardioplegia alone (Table 3). 56 Thus, beta-blockers appear to enhance recovery of function following cardioplegia.…”