Cardiac Metabolic Stress During Ischemia and Reperfusion in Patients Undergoing Coronary Artery Bypass Surgery Using Either Calafiore or Modified Del Nido Cardioplegic Solutions

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2024-10-16 DOI:10.1155/2024/5562548

Abd Alhade Massa, Ahmad Walid Izzat, Rakan Saadoun, Mohammad Bashar Izzat

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Abstract

Objective: Calafiore and modified del Nido cardioplegic solutions are currently being used during coronary artery bypass surgery. This study aims to compare myocardial ischemic stress associated with both solutions by studying the changes in cardiac metabolites during cardioplegic ischemic arrest and early reperfusion.

Methods: Biopsy specimens were taken from the left ventricles of 20 patients undergoing routine coronary artery bypass grafting using Calafiore or modified del Nido cardioplegic solutions. Biopsies were taken immediately after the beginning of extracorporeal circulation (basal biopsy), 30 min after application of the aortic cross-clamp (ischemic biopsy), and 20 min following the removal of aortic cross-clamp (reperfusion biopsy) and were analyzed for their amino acid and lactic acid contents using amino acid analyzer and appropriate kits. Peripheral blood samples were also collected for the determination of blood concentrations of cardiac proteins (CK-MB and troponin I) using an immunofluorescence scanner.

Results: Both CK-MB and troponin I increased significantly 12 h postoperatively and were associated with an increase in myocardial lactic acid, but there were no significant differences in markers of myocardial injury between the two groups. Comparison of amino acid concentrations between the two groups according to sampling time showed that glutamic acid concentrations were significantly lower in the Calafiore cardioplegia group compared to the del Nido cardioplegia group, but there were no other significant differences in markers of metabolic stress (taurine and alanine/glutamate ratio) between the two groups. Moreover, there were no significant differences in changes in amino acid concentrations regardless of the type of cardioplegic solution used.

Conclusions: Cardioplegic ischemic arrest and early reperfusion are associated with a rise in myocardial metabolic stress. Both Calafiore and modified del Nido cardioplegic solutions are effective in attenuating myocardial substrate derangements and confer equal myocardial protection during routine coronary artery bypass surgery.

Trial Registration: ClinicalTrials.gov identifier: NCT06287372

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使用卡拉菲奥雷或改良德尔尼多心脏麻痹溶液进行冠状动脉搭桥手术的患者在缺血和再灌注期间的心脏代谢压力

目的：目前在冠状动脉搭桥手术中使用卡拉菲奥雷和改良德尔尼多心脏麻痹溶液。本研究旨在通过研究心脏麻痹缺血停止和早期再灌注过程中心脏代谢物的变化，比较两种溶液对心肌造成的缺血压力。研究方法活检标本取自 20 名接受常规冠状动脉旁路移植术的患者的左心室，使用的是卡拉菲奥雷或改良德尔尼多心脏麻痹溶液。活组织样本分别在体外循环开始后立即提取（基础活组织样本）、使用主动脉交叉夹钳 30 分钟后提取（缺血活组织样本）和去除主动脉交叉夹钳 20 分钟后提取（再灌注活组织样本），并使用氨基酸分析仪和适当的试剂盒分析其氨基酸和乳酸含量。此外，还采集了外周血样本，使用免疫荧光扫描仪测定血液中心脏蛋白（CK-MB 和肌钙蛋白 I）的浓度。结果术后 12 小时，CK-MB 和肌钙蛋白 I 均明显增加，且与心肌乳酸的增加有关，但两组心肌损伤指标无明显差异。根据取样时间比较两组的氨基酸浓度发现，卡拉菲奥雷心脏麻痹组的谷氨酸浓度明显低于德尔尼多心脏麻痹组，但两组在代谢压力指标（牛磺酸和丙氨酸/谷氨酸比率）方面没有其他显著差异。此外，无论使用哪种心脏麻痹溶液，氨基酸浓度的变化均无明显差异。结论心肌缺血停搏和早期再灌注与心肌代谢应激的增加有关。在常规冠状动脉搭桥手术中，Calafiore 和改良 del Nido 两种心脏麻痹溶液都能有效减轻心肌底物紊乱，并提供同等的心肌保护。试验注册：临床试验注册：ClinicalTrials.gov identifier：NCT06287372

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.