Warm versus cold cardioplegia for heart surgery: a meta-analysis

Fan, Yu; Zhang, Anmei; Ye, Xiao; Weng, Yuguo; Hetzer, Roland

doi:10.1016/j.ejcts.2009.09.030

Cited by 92 publications

(98 citation statements)

References 40 publications

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“…Indeed, Buckberg et al demonstrated that electromechanical arrest alone decreases myocardial oxygen requirements by nearly 90%, with only a slight further decrease when lowering myocardial temperature [20]. A recent meta-analysis also demonstrated similar low output syndrome incidence and intra-aortic balloon pump usage with cold and warm cardioplegia [3].…”

Section: Discussionmentioning

confidence: 74%

“…While cold crystalloid cardioplegia ensures myocardial protection by decreasing myocardial oxygen requirements [11], warm blood cardioplegia was considered to improve metabolic and functional recovery of the myocardium [3] and has therefore been adopted by many surgical teams. However, studies such as the Emory Trial failed to demonstrate better myocardial protection with warm cardioplegia and reported significantly higher rates of neurological events in this group [12].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, deep myocardial hypothermia decreases the activity of myocardial enzymes, causing delayed myocardial recovery after surgery [2]. Warm blood cardioplegia appears to overcome these drawbacks, providing better myocardial protection and less myocardial injury, although no significant difference was noticed in terms of clinical outcomes [3]. Moreover, the increased risk of hyperkalemia [4], impaired visualization during the construction of coronary anastomoses, and the technical problems encountered particularly in neonatal cardiac surgery [5] limit the utility of this technique.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Improved cardiac protection with Sabax cardioplegia in Langendorff isolated rat hearts

Perian

Mărginean

Dobreanu

et al. 2014

Acta Medica Marisiensis

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Objective: Cardioplegia is an important step to facilitate cardiac surgery while limiting intraoperative myocardial injury. Although recent advances in cardioplegic arrest methods have significantly contributed to better postoperative outcomes, there is still controversy regarding the optimal composition and temperature of the cardioplegic solution. Accordingly, we aimed to assess whether cold or lukewarm Sabax cardioplegia offer improved myocardial protection compared with the classical Krebs-Henseleit solution. Methods: The hearts of 40 male Wistar rats were isolated and submitted to constant-flow retrograde perfusion using a Langendorff perfusion apparatus. The hearts were randomly assigned to cold Krebs-Henseleit (K-H), cold Sabax, or lukewarm Sabax cardioplegia. The ECG, heart rates, and left ventricular systolic pressures (LVSP) were recorded pre-and post-cardioplegia. The time needed for cardioplegia induction and post-cardioplegia recovery were also noted. Results: Both cold and lukewarm Sabax cardioplegia insured faster induction and faster recovery following isothermic reperfusion compared to the standard K-H solution (both p< 0.01). With K-H cardioplegia, the hearts presented a 21.7% force loss after reperfusion (p< 0.001), whilst Sabax cardioplegia was associated with a slight increase in ventricular mechanical activity (3% LVSP increase with lukewarm Sabax cardioplegia, p< 0.001 and 2% LVSP increase with cold Sabax cardioplegia, p = 0.02). With Sabax cardioplegia the hearts displayed considerably less major arrhythmic events and presented less significant bradycardia. Conclusions: The present data suggest that Sabax cardioplegia may be superior to the classical cold crystalloid K-H solution in preserving mechanical activity of the heart and may provide superior protection against major arrhythmias.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Improved cardiac protection with Sabax cardioplegia in Langendorff isolated rat hearts

Perian

Mărginean

Dobreanu

et al. 2014

Acta Medica Marisiensis

View full text Add to dashboard Cite

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“…Guru, Jacob and their coworkers (14,15) in two metaanalyses showed that cold blood cardioplegia provides a favorable outcome in terms of lower incidence of low cardiac output syndrome, CK-MB release in comparison with CCC, but the incidence of myocardial infarction and death were similar. In another two meta-analyses Fan, Abah, and their colleagues (16,17) showed no difference between warm and cold cardioplegia on the short-term mortality. Jacquet and Coworkers (18), on 200 patients undergoing coronary artery bypass grafting showed as a better method of myocardial protection the antegrade warm cardioplegia in comparison with combined antegrade and retrograde CCC on the PO cardiac enzymes release, although ischemic arrest duration was significantly shorter in the warm group.…”

Section: Discussionmentioning

confidence: 99%

Cold crystalloid versus warm blood cardioplegia in patients undergoing aortic valve replacement

et al. 2018

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Background: Myocardial protection techniques during cardiac arrest have been extensively investigated in the clinical setting of coronary revascularization. Fewer studies have been carried out of patients affected by left ventricular hypertrophy, where the choice of type and temperature of cardioplegia remain controversial.We have retrospectively investigated myocardial injury and short-term outcome in patients undergoing aortic valve replacement plus or minus coronary artery bypass grafting with using cold crystalloid cardioplegia (CCC) or warm blood cardioplegia (WBC). Methods: From January 2015 to October 2016, 191 consecutive patients underwent aortic valve replacement plus or minus coronary artery bypass grafting in normothermic cardiopulmonary bypass.Cardiac arrest was obtained with use of intermittent antegrade CCC group (n=32) or WBC group (n=159), according with the choice of the surgeon. Results: As compared with WBC group, in CCC group creatine-kinase-MB (CK-MB), cardiac troponin I (cTnI), aspartate aminotransferase (AST) release, and their peak levels, were lower during each time points of evaluation, with the greater statistically significant difference at time 0 (P<0.05, for all comparisons). A time 0, CK-MB/CK ratio >10% was 5.9% in CCC group versus 7.8% in WBC group (P<0.0001). At time 0 CK-MB/CK ratio >10% in patients undergoing isolated aortic valve replacement was 6.0% in CCC group versus 8.0% in WBC group (P<0.01). No any difference was found in perioperative myocardial infarction (0% versus 3.8%), postoperative (PO) major complications (15.6% versus 16.4%), in-hospital mortality (3.1% versus 1.3%). Conclusions: In aortic valve surgery a significant decrease of myocardial enzymes release is observed in favor of CCC, but this difference does not translate into different clinical outcome. However, this study suggests that in presence of cardiac surgical conditions associated with significant left ventricular hypertrophy, i.e., the aortic valve disease, a better myocardial protection can be achieved with the use of a cold rather than a warm cardioplegia. Therefore, CCC can be still safely used.

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“…Successful coronary artery bypass grafting (CABG) requires effective myocardial protection and preservation. Although several approaches for myocardial preservation during cardiopulmonary bypass (CPB) have been introduced till now, controversy still exists regarding the best method for this purpose [3][4][5]. The preferred way to protect myocardium is delivering of adequate cardioplegic solution to whole myocardium, and severe occlusion of the coronary arteries limit this delivery by the antegrade route [6].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Serum Myocardial Biomarkers Following Two Different Methods of Venoaortic Connection in Coronary Artery Bypass Grafting: A Randomized Clinical Trial

Jelodar

Zarrabi

Nazifi

et al. 2017

Zahedan J Res Med Sci

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Background: Myocardium will expose to excessive ischemia and reperfusion during post-cardiac surgery, hence the aim of this study was to investigate the cardioprotective effect of sequential partial aortic side biting technique for proximal veno-aortic anastomosis constructions in patients undergoing coronary artery bypass grafting (CABG). Methods: In this randomized clinical trial study, 60 consecutive patients who were diagnosed to suffering from triple vessel coronary artery diseases were selected. CABG patients were assigned randomly into two groups; the first group received sooner and gradual myocardial reperfusion one-by-one top end venous anastomosis to the aorta (sequential aortic side biting technique) (n = 30) and the second group undergo proximal anastomoses constructed during a single period of aortic side biting (single aortic side biting technique) (n = 30). The serum levels of myocardial damage biomarkers including creatine phosphokinase-MB (CPK-MB), Troponin I, glutathione peroxidase (GPX), superoxide dismutase (SOD), malondialdehyde (MDA) and catalase (CAT) were measured preoperatively, postoperatively and 24 h after operation. Independent t-tests was used to compare results between groups. Results: The level of all myocardial biomarkers increased after the operation. Those in study group had significantly lower levels of troponin I (P < 0.001), CPK-MB (P = 0.001), GPX (P = 0.007), SOD (P = 0.005), and CAT (P = 0.015), 24h after the operation when compared to control group. Only the serum level of CPK-MB was significantly lower in study group after the operation (P = 0.029) while the other markers were comparable. Conclusions: Sequential partial occluding aortic side biting technique associated with less myocardial damage and ischemiareperfusion injury compared to conventional single method in patients undergoing elective coronary grafting.

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Warm versus cold cardioplegia for heart surgery: a meta-analysis

Cited by 92 publications

References 40 publications

Improved cardiac protection with Sabax cardioplegia in Langendorff isolated rat hearts

Improved cardiac protection with Sabax cardioplegia in Langendorff isolated rat hearts

Cold crystalloid versus warm blood cardioplegia in patients undergoing aortic valve replacement

Comparison of Serum Myocardial Biomarkers Following Two Different Methods of Venoaortic Connection in Coronary Artery Bypass Grafting: A Randomized Clinical Trial

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