What question did this study set out to answer?

To evaluate myocardial energy metabolism during aortic valve replacement protected by hypothermic potassium crystalloid cardioplegia supplemented with mannitol.

January 1, 1986Scandinavian Journal of Thoracic and Cardiovascular Surgery

Myocardial metabolism during aortic valve replacement: I.Hypothermic Crystalloid Cardioplegia with Mannitol

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Aortic valve replacement (n=5). Intervention: Hypothermic potassium cardioplegia with addition of mannitol. Primary outcome: Myocardial energy metabolism (ATP, lactate, and glycogen concentrations).

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Key result

Hypothermic potassium cardioplegia plus mannitol fails to prevent pronounced anaerobic metabolism during aortic valve replacement.

Why the study?

Does the addition of mannitol to hypothermic potassium cardioplegia prevent anaerobic myocardial metabolism in patients undergoing aortic valve replacement?

Population

5 patients undergoing aortic valve replacement

Design

Case_series

Follow-up

Intraoperative (during aortic cross-clamping)

Authors

EJEva JanssonKarolinska University Hospital VBV. BomfimKarolinska University Hospital LKL. KaijserUppsala University

Discussion

Member takes

Implication

Case series cautions against assuming mannitol prevents anaerobic metabolism in AVR cardioplegia; leaves open need for optimized protection strategies.

Key Points

To evaluate myocardial energy metabolism during aortic valve replacement protected by hypothermic potassium crystalloid cardioplegia supplemented with mannitol.
Assessed 5 patients undergoing aortic valve replacement using hypothermic potassium cardioplegia combined with mannitol.
Obtained left ventricular myocardial biopsies 10 minutes following aortic cross-clamping and immediately before declamping to measure ATP, lactate, and glycogen concentrations.
ATP levels decreased from 13.2 ± 3.6 to 11.0 ± 4.3 mmol/kg dry muscle, and glycogen decreased from 181 ± 54 to 143 ± 3 mmol/kg dry muscle across the cross-clamping interval.
Myocardial lactate rose from 61.5 ± 17.6 to 86.6 ± 13.3 mmol/kg dry muscle, demonstrating marked anaerobic metabolism during aortic cross-clamping.

Study Design

Type

Observational (n=5)

Structured PICO

Does the addition of mannitol to hypothermic potassium cardioplegia prevent anaerobic myocardial metabolism in patients undergoing aortic valve replacement?

Population

5 patients undergoing aortic valve replacement.

Exposure

Hypothermic potassium crystalloid cardioplegia with addition of mannitol

Outcome

Myocardial energy metabolism (ATP, lactate, and glycogen concentrations) measured via left ventricular biopsiessurrogate

The addition of mannitol to crystalloid cardioplegia does not prevent pronounced anaerobic metabolism during aortic valve replacement.

Cite This Study

Jansson et al. (1986) conducted an observational in Aortic valve replacement (n=5). Hypothermic potassium cardioplegia with addition of mannitol was evaluated on Myocardial energy metabolism (ATP, lactate, and glycogen concentrations). Hypothermic potassium cardioplegia with mannitol did not prevent pronounced anaerobic metabolism during aortic valve replacement, evidenced by falling ATP and rising lactate levels.

synapsesocial.com/papers/6aa43177e7e1fc23507496cc https://doi.org/10.3109/14017438609106490

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Implication

Case series cautions against assuming mannitol prevents anaerobic metabolism in AVR cardioplegia; leaves open need for optimized protection strategies.

Myocardial metabolism during aortic valve replacement: I.Hypothermic Crystalloid Cardioplegia with Mannitol

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Myocardial metabolism during aortic valve replacement: I.Hypothermic Crystalloid Cardioplegia with Mannitol

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

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