Key result
Warm blood cardioplegia provided better myocardial protection than cold crystalloid cardioplegia, as evidenced by significantly lower ischemia-modified albumin levels at 24 hours postoperatively (p <0.05).
Why the study?
Does warm blood cardioplegia reduce cellular injury and oxidative stress compared to cold crystalloid cardioplegia in patients undergoing coronary bypass surgery?
RCT (n=60)
Sealed envelope method
No
Does warm blood cardioplegia reduce cellular injury and oxidative stress compared to cold crystalloid cardioplegia in patients undergoing coronary bypass surgery?
Absolute Event Rate: 0.45% vs 0.62%
p-value: p=<0.05
Warm blood cardioplegia may offer better myocardial protection against oxidative stress compared to cold crystalloid cardioplegia during coronary bypass surgery, as evidenced by lower ischemia-modified albumin levels.
No differential oxidative effects seen; leaves open optimal cardioplegia selection for endothelial integrity in CABG.
PURPOSE: The purpose of this study was to evaluate the effect of different cardioplegic solutions on endothelial integrity and oxidative stress in cardiovascular surgery. METHODS: In this randomized prospective study, after ethics approval and informed consent, 60 surgical patients were included. Patients undergoing coronary bypass surgery were randomized into two groups as warm blood cardioplegia (n = 30) and cold crystalloid cardioplegia (n = 30) following the cross-clamping. Measurements were performed at three time points: before induction of anesthesia (T1), at admission to intensive care unit (ICU) (T2) and at the 24th postoperative hour (T3). Besides biochemical routine hemodynamic monitoring, patients were assessed for the sialic acid (SA), ischemic-modified albumin (IMA), advanced oxide protein products (AOPPs), total thiol (SH), and free hemoglobin (fHb) level. RESULTS: Neither crystalloid nor blood cardioplegia led to significant changes in the AOPPs, T-SH, and SA level (p >0.05). Crystalloid cardioplegia, however, increased IMA level compared to both baseline (p <0.01) and blood cardioplegia group (p <0.05). fHb levels were transiently increased in both groups at the second-time point (p <0.001). fHb level was lower in the crystalloid group compared to that in the other group (p <0.05) at T2. CONCLUSION: Cardioplegia type creates similar effects on glycocalyx integrity. However, myocardial protection could be provided with warm blood cardioplegia.
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Ulugöl et al. (2018) conducted an RCT in Cardiovascular surgery (n=60). Warm blood cardioplegia vs. Cold crystalloid cardioplegia was evaluated on Ischemia-modified albumin (IMA) level at 24 hours postoperatively (AbsUnit) (p=<0.05). Warm blood cardioplegia provided better myocardial protection than cold crystalloid cardioplegia, as evidenced by significantly lower ischemia-modified albumin levels at 24 hours postoperatively (p <0.05).
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