Keywords
Intracellular Solutions
Calcium paradox
Protective Efficacy
Cellular Metabolism
How to Cite
Abstract
This study investigates the impact of crystalloid cardioplegic solutions (CCS) on electrophysiological mechanisms and the contractile system during the diastolic phase. Extracellular solutions, categorized by ion concentration, demonstrate efficacy in inducing cardiac arrest through moderately elevated potassium or potassium-magnesium combinations, aligning with normal or slightly reduced sodium and calcium levels. Notably, the ease of equilibration with myocardial tissue enhances the protective effect, correlating with infusion volume and duration of action. However, drawbacks such as low buffering capacity and the need for reinfusion after 15-20 minutes are identified. This research sheds light on the dynamic relationship between solution composition, duration of action, and protective efficacy, providing valuable insights for refining cardioplegic protocols in cardiac surgeries.
Highlights:
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Intracellular vs. Extracellular Impact: Explore ion concentration's influence on crystalloid cardioplegic solutions, emphasizing the choice between intracellular and extracellular formulations.
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Equilibration Dynamics: Investigate the direct correlation between infusion volume, duration of action, and the protective effect, emphasizing equilibration with myocardial tissue.
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Refining Cardioplegic Protocols: Identify limitations like low buffering capacity, necessitating reinfusion, and offer insights into strategies for enhancing cardioplegic protocols in cardiac surgeries.
Keywords: Cardioplegia, Intracellular Solutions, Calcium paradox, Protective Efficacy, Cellular Metabolism
References
B.C. Allen, M.J. Barth, and M.N. Ilbawi, "Pediatric myocardial protection: an overview," Sem. Thorac. Cardiovasc. Surg., vol. 13, pp. 56-72, 2001.
G. Begum, A. Cunliffe, and M. Leveritt, "Physiological role of carnosine in contracting muscle," Int. J. Sport Nutr. Exere. Metab., vol. 15, no. 5, pp. 493-514, 2005.
H.J. Bretschneider, "Myocardial protection," J. Thorac. Cardiovasc. Surg., vol. 28, pp. 295-302, 1980.
G.D. Buckberg, "Myocardial protection: an overview," Semin, J. Thorac. Cardiovasc. Surg., vol. 5, pp. 98-106, 1993.
M. Caputo et al., "Warm-blood cardioplegia with low or high magnesium for coronary bypass surgery," Eur. J. Cardiothorac. Surg., vol. 127, pp. 41-52, 2010.
D.J. Chambers, "Cardioplegia and cardiac surgery, Pharmacological arrest during global ischemia and reperfusion," Pharmacol. Ther., vol. 127, pp. 41-52, 2010.
T. Doenst et al., "Three good reasons for heart surgeons to understand cardiac metabolism," Eur. J. Cardiothorac. Surg., vol. 33, pp. 862-871, 2008.
R. Edwards et al., "A controlled trial of substrate-enhanced, warm reperfusion (shot shota) versus simple reperfusion," Ann. Thorac. Surg., vol. 69, pp. 551-555, 2000.
R.M. Engelman, A textbook of clinical cardioplegia. U.S.A, N.Y.C: Future Publishing Company, 1992.
H.J. Geisoder and U. Melhorn, "Colid crystallized cardioplegia," MMCTS, Jan. 2006, doi:10.1510.
D.J. Hearse et al., "Protection of the ischemic myocardium cardioplegia," New York: Raven Press, 1981.
R.A. Jonas, "Myocardial protection for neonates and infants," Thorac. Cardiovasc. Surg., vol. 46, pp. 288-291, 1998.
J.A. Magavern et al., "Protection of the immature myocardium. An experimental evaluation of topical cooling, single-dose, and multidose administration of St. Thomas Hospital cardioplegic solution," J. Thorac. Cardiovasc. Surg., vol. 96, pp. 408-413, 1998.
S. Sauerhofer et al., "L-earnosine, a substrate of carnosinae-1 influences glucose metabolism," Diabetes, vol. 56, no. 10, pp. 2425-32, 2007.
C.D. Schlensak et al., "Myocardial protection in congenital heart surgery," MMCTS, Nov. 2005, doi:10.1510.
C.D. Schlensak et al., "Cardioplegia in pediatric cardiac surgery: do we believe in magic," Ann. Thorac. Surg., vol. 75, pp. 1668-1677, 2003.
A.S. Tomas and R. Marco, "Myocardial protection," Future: Blackwell Publishing, 2004, p. 338.
T.B. Averina, R.R. Movsesyan, and G.A. Shebaev, "Modern strategies for myocardial protection in children," Children's heart and vascular diseases, no. 5, pp. 45-53, 2007.
L.A. Bokeria, "Manual of cardiovascular surgery," Ed. V.I. Burokovsky, Moscow, 1996.
L.A. Bokeria, R.R. Movsesyan, and R.A. Musina, "Current issues of intraoperative myocardial protection (cardiology)," Chest and cardiovascular surgery, no. 5, pp. 63-70, 1998.
L.A. Bokeria, R.R. Movsesyan, E.D. Niskevich et al., "Myocardial protection in newborns and infants during surgical treatment of congenital heart defects," Bulletin of the Bakulev NCSRSH, vol. 4, no. 7, pp. 5-25, 2003.
A.A. Boldyriev, "Carnosine. Biological significance and possibilities," Ed. A.A. Boldyriev, Moscow: Moscow State University Publishing House, 1998, pp. 82-105.
A.A. Boldyriev, V.V. Alabovsky, and A.A. Vinokurov et al., "Comparison of the protective action of carnosine and acetylcarnosine in cardioplegia process," Bull. experiment. biol. and med., vol. 127, no. 3, pp. 290-294, 1999.
A.I. Madashenkov, "Cardiology," Lectures on cardiovascular surgery, Ed. L.A. Bokeria, vol. 2, Moscow, 2001, pp. 185-199.
R.R. Movsesyan, "Myocardial protection in open heart surgery," Lectures on cardiovascular surgery, Ed. L.A. Bokeria, vol. 2, Moscow, 2001, pp. 203-217.
R.R. Movsesyan et al., "Additional anti-ischemic effect of carnosine and its derivatives in cardioplegic solution," Bulletin of the Bakulev NCSRSH, vol. 9, no. 1, pp. 98-105, 2008.
A.V. Smolensky, "Modern trends in intraoperative myocardial protection," Cardiovascular diseases, vol. 2, no. 2, 2011.
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