Cold blood cardioplegia resulted in significantly lower postoperative troponin I release at 1, 24, and 48 hours compared to warm blood cardioplegia (P<0.05) during aortic valve surgery.
RCT (n=35)
prospectively randomised
Does intermittent antegrade cold blood cardioplegia reduce myocardial injury compared to warm blood cardioplegia in patients with left ventricular hypertrophy undergoing aortic valve surgery?
Cold blood cardioplegia is associated with less ischemic stress and myocardial injury than warm blood cardioplegia in patients with hypertrophic hearts undergoing aortic valve surgery, though both techniques offer sub-optimal protection.
p-value: p=<0.05
OBJECTIVES: Myocardial protection techniques during cardiac surgery have been largely investigated in the clinical setting of coronary revascularisation. Few studies have been carried out on patients with left ventricular hypertrophy where the choice of delivery, and temperature of cardioplegia remain controversial. This study investigates metabolic changes and myocardial injury in hypertrophic hearts of patients undergoing aortic valve surgery using antegrade cold or warm blood cardioplegia. METHODS: Thirty-five patients were prospectively randomised to intermittent antegrade cold or warm blood cardioplegia. Left ventricular biopsies were collected at 5min following institution of cardiopulmonary bypass, 30min after cross-clamping the aorta and 20min after cross-clamp removal, and used to determine metabolic changes during surgery. Metabolites (adenine nucleotides, amino acids and lactate) were measured using high pressure liquid chromatography and enzymatic techniques. Postoperative myocardial troponin I release was used as a marker of myocardial injury. RESULTS: Ischaemic arrest was associated with significant increase in lactate and alanine/glutamate ratio only in the warm blood group. During reperfusion, alanine/glutamate ratio was higher than preischaemic levels in both groups, but the extent of the increase was considerably greater in the warm blood group. Troponin I release was markedly (P<0.05, Mean+/-SD) lower at 1, 24 and 48h postoperatively in the cold compared to the warm blood group (0.51+/-0.37, 0.37+/-0.22 and 0.27+/-0.19 vs. 0.75+/-0.42, 0.73+/-0.51 and 0.54+/-0.38ng/ml for cold vs. warm group, respectively). CONCLUSIONS: Cold blood cardioplegia is associated with less ischaemic stress and myocardial injury compared to warm blood cardioplegia in patients with aortic stenosis undergoing valve replacement surgery. Both cardioplegic techniques, however, confer sub-optimal myocardial protection.
Raimondo Ascione (Fri,) conducted a rct in aortic stenosis with left ventricular hypertrophy (n=35). intermittent antegrade cold blood cardioplegia vs. intermittent antegrade warm blood cardioplegia was evaluated on Postoperative myocardial troponin I release (p=<0.05). Cold blood cardioplegia resulted in significantly lower postoperative troponin I release at 1, 24, and 48 hours compared to warm blood cardioplegia (P<0.05) during aortic valve surgery.
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