Warm blood cardioplegia versus cold crystalloid cardioplegia for coronary artery bypass grafting (CABG) in patients with low ejection fraction

Mahrose, Ramy; Shorbagy, Mohamed S.; Shahin, Khaled M.; Al-Elwany, Shady Eid

doi:10.1186/s42077-020-00069-8

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…However, warm cardioplegia correlated with better postoperative cardiac indices and lower peak creatine kinase MB concentrations than cold cardioplegia [28]. The latter findings, along with reduced postoperative cardiac troponin levels, have been replicated in other studies [29,30]. Meanwhile, other studies comparing warm blood and cold crystalloid hyperkalemic cardioplegia do not show significant differences with respect to perioperative myocardial infarction and low cardiac output syndrome [31].…”

Section: Warm Vs Coldmentioning

confidence: 74%

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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Section: Warm Vs Coldmentioning

confidence: 74%

Potassium and Cardiac Surgery

Kant¹,

Sellke²,

Feng³

2022

Physiology

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“…These results support our study 22 . In a second trial, there was no difference found in the postoperative release of CK-MB in the first 48 hours between the two groups (p=0.86) 19,20,21,22,23 .…”

Section: Discussionmentioning

confidence: 86%

Correlation of Post-Operative Outcomes in patients undergoing CABG Receiving Antegradecardioplegia alone Versus Combined Antegrade Plus Retrograde Cardioplegia: A Prospective Review

Jabeen¹,

Arif²,

Bukhari³

et al. 2023

PJMHS

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Aim: To compare the mean ejection fraction and cardiac enzymes level in patients with Ischemic heart disease undergoing elective coronary artery bypass graft surgery (CABG) having antegrade blood cardioplegia versus antegrade plus retrograde Cardioplegia. Study design: Randomized Controlled Trial Place and duration: This study was performed from 7th February, 2020 to 7th August, 2020 at the Cardiac Surgery Department, PIC, Jail Road, Lahore. Methodology: After receiving informed consent, all patients undergoing CABG were enrolled in this study. In order to compare the mean ejection fraction and cardiac enzyme levels between patients who had antegrade blood cardioplegia and those who had antegrade plus retrograde cardioplegia, preoperative, intraoperative, and postoperative characteristics were recorded into the predesigned proforma. Results: The total number of patients 72 was enrolled in this study who were divided into two groups. There were 36(50%) patients of who have given Cardioplegia through antegrade route while CABG and 36(50%) patients who have given Cardioplegia through antegrade plus retrograde route while CABG in this study. According to Table 1, the mean age of the patients in Group A was 51.86±9.35 years, whereas the mean ages of the participants in Group B 52.92±7.70 years. There were 26(72%) male and 10(28%) females in Group A and 30(83%) male and 6(17%) females in Group B. The mean BMI in Group A was 25.65±5.18 and 25.02±3.97 in Group B. There were 35(97%) hypertensive and 1(3%) non hypertensive patients in Group A and B respectively. Similarly, there were 33(92%) diabetic and 3(8%) non diabetic patients in Group A and 28 (78%) diabetic and 8(22%) non diabetic patients were in Group B. There were 26(72%) smokers and 10(28%) non- smokers in Group A and 24 (67%) smokers and 12(33%) non-smokers in this Group B. Practical Implication: The comparison of CKMB(IU/L) levels in Antegrade route group and antegrade plus retrograde group baseline and after 48 hours shows insignificant p-values of 0.17 and 0.12 respectively which shows that there is no significant difference in CKMB levels regarding these two routes chosen for giving Cardioplegia to patients undergoing coronary artery bypass grafting. Conclusion: Although both required additional surgical manoeuvres, however, the antegrade and antegrade plus retrograde cardioplegia approaches were equally effective and safe. Prior research demonstrated that multiple infusions offer superior protection to either antegrade or retrograde cardioplegia alone. Keywords: Coronary artery Bypass grafting surgery, Antegrade route, Retrograde Route, Antegrade plus Retrograde route.

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“…Blood cardioplegia at physiological temperature will improve the postoperative outcome for better myocardial protection due to the improvement of oxygen availability. Also, blood will improve the oxygen carrying capacity and is less accompanied with hemodilution 5 . Although cold cardioplegia can lower myocardial oxygen consumption and demands, myocardial enzymes may inhibit and delay metabolic and functional cardiac recovery after surgery.…”

Section: Introductionmentioning

confidence: 99%

Comparison of CKMB, Lactate Levels and Ejection Fraction with Warm and Cold Cardioplegia on First Post Operative Day in Elective CABG Cases

Ahmad¹,

Siddique²,

Sadiq³

2022

PJMHS

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Objectives: The main objective of the study is to find the comparison of CKMB, Lactate levels and ejection fraction with warm and cold cardioplegia on first post OP day in elective CABG cases. Material and methods: This cross sectional study was conducted in Armed forces institute of cardiology AFIC /NIHD Rawalpindi during 1st October 2022 to 30th November 2022. Data was collected with the permission of ethical committee of hospital. The study variables were included level of troponin I during intraoperative and post-operative period, time taken for cardiac standstill, CKMB, Lactate levels and ejection fraction with warm and cold cardioplegia, post-operative improvement in ejection fraction, number of days in ICU. Results: The data was collected from 100 patients. There was no statistically significant difference between the two groups as regards bypass and cross clamp times. Mean age of group I patients was 61.3 ± 12.5 years and for group II patients was 67.4 ± 10.4 years. P value of serum lactate level is <0.01, which is statistically significant. All the patients had elevated lactate level but the range of increase in lactate level was seen in those who didn’t take adenosine as compared to those who took adenosine. Practical Implications: Enzymes play an important role in both cold and warm cardioplegia. Conclusion: It is concluded that there is less cardiac enzymes release after the application of warm blood cardioplegia for myocardial protection in patients undergoing CABG as compared to cold crystalloid cardioplegia. Keywords: Cardioplegia, CKMB, Troponin, CABG, Cold

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Warm blood cardioplegia versus cold crystalloid cardioplegia for coronary artery bypass grafting (CABG) in patients with low ejection fraction

Cited by 5 publications

References 8 publications

Potassium and Cardiac Surgery

Potassium and Cardiac Surgery

Correlation of Post-Operative Outcomes in patients undergoing CABG Receiving Antegradecardioplegia alone Versus Combined Antegrade Plus Retrograde Cardioplegia: A Prospective Review

Comparison of CKMB, Lactate Levels and Ejection Fraction with Warm and Cold Cardioplegia on First Post Operative Day in Elective CABG Cases

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