Magnesium-supplemented warm blood cardioplegia in patients undergoing coronary artery revascularization

Yeatman, Mark; Caputo, Massimo; Narayan, Pradeep; Lotto, A; Ascione, Raimondo; Bryan, Alan J.; Angelini, Gianni D

doi:10.1016/s0003-4975(01)03270-2

Cited by 32 publications

(36 citation statements)

References 24 publications

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“…In the case of cardioplegia, the addition of Mg is the standard of care at our institution, and several of the participating surgeons did not feel comfortable removing it. Although this may have been a confounding factor, given the results of a recently published study 18 that found a significantly lower incidence of postoperative AF in patients who received Mg in their cardioplegia, the effect in our study would have been consistent in all patients irrespective of randomization. The decision was made to allow for open-label Mg in the CSICU because serum Mg levels are routinely checked in the CSICU, and many staff members were uncomfortable with leaving patients with untreated hypomagnesemia.…”

Section: Limitationsmentioning

confidence: 56%

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Prophylactic Intravenous Magnesium Sulphate in Addition to Oral β-Blockade Does Not Prevent Atrial Arrhythmias After Coronary Artery or Valvular Heart Surgery

et al. 2009

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Background-Atrial arrhythmias (AA) are an important cause of morbidity after cardiac surgery. Efforts at prevention of postoperative AA have been suboptimal. Perioperative beta-blocker administration is the standard of care at many centers. Although prophylactic administration of magnesium sulfate (MgSO 4 ) has been recommended, review of all previously published trials of MgSO 4 reveals conflicting results. This study was designed to address methodological shortcomings from previous studies and is the largest randomized, placebo-controlled trial of intravenous (IV) MgSO 4 for the prevention of AA after coronary artery bypass grafting or cardiac valvular surgery. Methods and Results-A total of 927 nonemergent cardiac surgery patients were stratified into 2 groups: isolated coronary artery bypass grafting (nϭ694), or valve surgery with or without coronary artery bypass grafting (nϭ233), and randomized to receive either 5g IV MgSO 4 or placebo on removal of the cross-clamp, followed by daily 4-hour infusions, from postoperative day 1 until postoperative day 4. All patients were treated according to an established oral ␤-blocker protocol. Postoperative serum Mg levels were checked and standard of care was to administer IV MgSO 4 for low serum levels. The primary end point was AA lasting Ն30 minutes or requiring treatment for hemodynamic compromise. There were no differences in the incidence of AA between patients who received IV MgSO 4 or placebo (26.4% versus 24.3%, respectively). The results were similar when broken down according to stratified groups. Conclusions-In patients treated with a protocol for postoperative oral ␤-blocker after nonemergent cardiac surgery, the addition of prophylactic IV MgSO 4 did not reduce the incidence of AA. (Circulation. 2009;120[suppl 1]:S163-S169.)

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Section: Limitationsmentioning

confidence: 56%

“…18 Most of the other trials had 50 to 60 patients in each arm, with 1 having as few as 9 patients in 1 arm. 20 Second, compared to other randomized trials, we had a relatively strict and conservative definition of AA (lasting Ն30 minutes on telemetry or associated with hemodynamic compromise requiring immediate therapy).…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Intravenous Magnesium Sulphate in Addition to Oral β-Blockade Does Not Prevent Atrial Arrhythmias After Coronary Artery or Valvular Heart Surgery

et al. 2009

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“…Bypass was commenced with cannulation of the ascending aorta and two-stage venous cannulation via the right atrial appendage. Flow was nonpulsatile at a rate of 2.6 l/min per m 2 and myocardial protection achieved with intermittent anterograde hyperkalaemic warm blood cardioplegia [9]. The haematocrit was maintained at approximately 25% during CPB.…”

Section: Surgical Techniquementioning

confidence: 99%

Effect of cardiopulmonary bypass on cortical cerebral oxygenation during coronary artery bypass grafting

Talpahewa

Lovell

Angelini

et al. 2004

European Journal of Cardio-Thoracic Surgery

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“…Using three cardioplegia solutions (3-4 mM Mg, 8-10 mM Mg, and 16-18 mM Mg), it was found that the 8-to 10-mM Mg cardioplegia solution yielded higher auto-resuscitation following surgery, shorter mechanical ventilation, shorter intensive care unit (ICU) stays, and the lowest creatine kinase MB isoenzyme (CK-MB) and troponin I levels [54]. The addition of Mg to warm blood cardioplegia resulted in a lower incidence of intraoperative and postoperative arrhythmias in patients undergoing urgent CABG for unstable angina [55].…”

Section: Routes Of Mg Administrationmentioning

confidence: 99%

Monitoring magnesium to guide magnesium therapy for heart surgery

Shirey¹

2004

Journal of Anesthesia

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ionized Mg (iMg). Measurement of TMg requires the isolation of plasma (centrifugation of blood sample) or serum (clotting and centrifugation of blood sample). Measurement is made by atomic absorption spectrophotometry or colorimetry. Reference values for plasma and serum TMg typically range from 0.66 to 1.07 mmol·l Ϫ1 . There is virtually no correlation between plasma/serum TMg and intracellular TMg.Ionized magnesium (iMg ϭ Mg 2ϩ ) represents the activity of unbound Mg in whole blood plasma, plasma, and/or serum. It is the physiologically active Mg fraction, i.e., the fraction to which tissues respond. Reference values typically range from 0.45 to 0.62 mmol·l Ϫ1 . The fact that it can be measured in a whole blood sample by electrode produces a rapid result (Ͻ150 s) on a small sample (Ͻ200 µl). A rapid result can be very helpful for patients (1) with arrhythmia, (2) with changes in cardiac output, (3) receiving cardiovascular drugs, (4) sustaining hypoxic damage, and (5) receiving Mg therapy. Blood plasma iMg correlates with intracellular iMg and therefore represents a better indicator of Mg status than TMg. It is typically 70% of the TMg value, but varies with the protein and small ligand concentrations in the blood. The iMg value may be substantially less than 70% of the TMg value in critically ill patients where binding ligand concentrations (heparin, citrate, lactate, phosphate, bicarbonate, etc.) have increased.Comparisons of iMg to TMg were illustrated in nine clinical settings (hypertension, acute myocardial infarction, head trauma, noninsulin-dependent diabetes, stroke, pregnancy, ischemic heart disease, cyclosporin recipients, and asthma) [3]. Ionized magnesium was found to be a better indicator of disease than TMg. In summary, iMg (1) represents the physiologically important Mg measurement, (2) is a better indicator of disease than TMg, and (3) is a more rapid measurement.The literature should be interpreted with caution. Frequently, if not generally, the Mg values reported in

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Magnesium-supplemented warm blood cardioplegia in patients undergoing coronary artery revascularization

Cited by 32 publications

References 24 publications

Prophylactic Intravenous Magnesium Sulphate in Addition to Oral β-Blockade Does Not Prevent Atrial Arrhythmias After Coronary Artery or Valvular Heart Surgery

Prophylactic Intravenous Magnesium Sulphate in Addition to Oral β-Blockade Does Not Prevent Atrial Arrhythmias After Coronary Artery or Valvular Heart Surgery

Effect of cardiopulmonary bypass on cortical cerebral oxygenation during coronary artery bypass grafting

Monitoring magnesium to guide magnesium therapy for heart surgery

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