The Experts below are selected from a list of 17451 Experts worldwide ranked by ideXlab platform
Richard J. Shemin - One of the best experts on this subject based on the ideXlab platform.
-
Warm versus cold blood Cardioplegia : is there a difference ?
The Journal of thoracic and cardiovascular surgery, 1993Co-Authors: Hiroshi Matsuura, Harold L. Lazar, Ximing Yang, Samuel Rivers, Patrick Treanor, Sheilah Bernard, Richard J. SheminAbstract:This experimental study sought to compare the effectiveness of warm blood Cardioplegia versus cold blood Cardioplegia in protecting areas of ischemic myocardium during urgent coronary revascularization. In 40 adult pigs, the second and third diagonal vessels were occluded with snares for 90 minutes. All animals were then placed on cardiopulmonary bypass and underwent 45 minutes of cardioplegic arrest followed by 3 hours of reperfusion during which time the coronary snares were released. During the period of cardioplegic arrest, 10 pigs received antegrade continuous warm blood cardioplegic solution (37° C) at 100 ml/min; 10 animals received retrograde warm blood cardioplegic solution at 100 ml/min; 10 received intermittent, antegrade cold blood cardioplegic solution (4° C), and 10 animals received intermittent, antegrade/retrograde cold blood cardioplegic solution. Hearts protected with antegrade warm blood cardioplegic solution had the lowest pH values in the area at risk (6.59 ± 0.10 antegrade warm blood Cardioplegia versus 6.80 ± 0.10 retrograde warm blood Cardioplegia versus 6.72 ± 0.18 antegrade cold blood Cardioplegia versus 6.85 ± 0.15 antegrade/retrograde cold blood Cardioplegia and the highest area of necrosis (42 % ± 3 % antegrade warm blood Cardioplegia versus 26% ± 2% [p
-
Detrimental effects of interrupting warm blood Cardioplegia during coronary revascularization.
The Journal of thoracic and cardiovascular surgery, 1993Co-Authors: Hiroshi Matsuura, Harold L. Lazar, Ximing Yang, Samuel Rivers, Patrick Treanor, Richard J. SheminAbstract:Warm blood Cardioplegia has emerged as a substitute for cold blood Cardioplegia as a method of myocardial protection. However, the continuous infusion of blood in this technique may obscure the operative field and necessitate interruption of warm blood Cardioplegia. This experimental study was therefore undertaken to determine whether interrupting warm blood Cardioplegia during coronary revascularization would increase myocardial damage. In 30 adult pigs, the second and third diagonal vessels were occluded with snares for 90 minutes. All animals underwent cardiopulmonary bypass and 45 minutes of cardioplegic arrest. During the period of cardioplegic arrest, 10 pigs received intermittent antegrade/retrograde infusion of cold blood cardioplegic solution (4 degrees C) 10 pigs received continuous retrograde infusion of warm blood cardioplegic solution (37 degrees C) at 100 ml/min, and 10 pigs received retrograde infusion of warm blood cardioplegic solution that was interrupted for three 7-minute periods. After aortic unclamping, the coronary snares were released and all hearts were reperfused for 180 minutes. Interrupting retrograde warm blood Cardioplegia resulted in more tissue acidosis during cardioplegic arrest (6.20 +/- 0.16 interrupted retrograde warm blood Cardioplegia and 6.45 +/- 0.12 continuous retrograde warm blood Cardioplegia, both p < 0.05 compared with 6.98 +/- 0.17 intermittent antegrade and retrograde cold blood Cardioplegia), decreased echocardiographic wall-motion scores (4 [normal] to -1 [dyskinesis]; 2.06 +/- 0.30 interrupted retrograde warm blood Cardioplegia, p < 0.05 compared with 3.30 +/- 0.40 intermittent antegrade and retrograde cold blood Cardioplegia, 2.80 +/- 0.40 continuous retrograde warm blood Cardioplegia), and increased tissue necrosis as measured by the area of necrosis/area at risk (38% +/- 5% interrupted retrograde warm blood Cardioplegia, p < 0.05 compared with 21% +/- 2% intermittent antegrade and retrograde cold blood Cardioplegia; 25% +/- 2% continuous retrograde warm blood Cardioplegia). We concluded that interrupting warm blood Cardioplegia during coronary revascularization diminishes the effectiveness of warm blood Cardioplegia and results in increased ischemic damage.
-
Superiority of Retrograde Cardioplegia Coronary Occlusion
1991Co-Authors: Constance K. Haan, Harold L. Lazar, Sheilah Bernard, Richard J. Shemin, John Zallnick, Samuel RiversAbstract:Because antegrade Cardioplegia may limit the distribution of Cardioplegia beyond a coronary occlusion, this study was undertaken to determine whether retrograde coronary sinus Cardioplegia provides superior myocardial protection during revascularization of an acute coronary occlusion. In 20 adult pigs, the second and third diagonal branches were occluded with a snare for 1?h hours. Animals were then placed on cardiopulmonary bypass and underwent 30 minutes of ischemic arrest with multidose, potassium, crystalloid Cardioplegia. In 10 animals, the Cardioplegia was given antegrade through the aortic root, whereas in 10 others, it was given retrograde through the coronary sinus. After the arrest period, the coronary snares were released and all hearts were reperfused for 3 hours. Postischemic damage in the he presence of coronary occlusions can alter the T distribution of antegrade Cardioplegia [l]. This can lead to myocardial injury and depressed postoperative left ventricular function. Experimental studies have shown that in the presence of coronary occlusions, retrograde Cardioplegia results in better myocardial cooling and more complete recovery of function in the area of the myocardium beyond the occlusions [24]. Nevertheless, recent clinical studies in patients undergoing coronary artery bypass grafting have shown that retrograde Cardioplegia appears to offer no additional myocardial protection as compared with antegrade techniques [5, 61. In these studies, patients had normal ventricular function and stable angina patterns. A more accurate assessment of the potential advantages of retrograde Cardioplegia would be in the setting of acute coronary ischemia such as that which occurs after a failed balloon angioplasty. Attempts to assess the clinical efficacy of a Cardioplegia technique after emergent coronary artery bypass grafting are always difficult because of persistent postoperative wall motion changes, which may be independent of the degree of protection and the relative insensitivity of enzyme levels and scanning techniques. Histochemical staining techniques in the area of risk may be a more sensitive variable to judge the benefits of a cardioplegic
Bjorn Braathen - One of the best experts on this subject based on the ideXlab platform.
-
one single dose of histidine tryptophan ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repetitive cold blood Cardioplegia a prospective randomized study
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Bjorn Braathen, Anders Jeppsson, Henrik Schersten, Ole Magnus Hagen, Oystein Vengen, Helena Rexius, Vincenzo LeporeAbstract:Objectives Histidine-tryptophan-ketoglutarate (HTK–Custodiol) cardioplegic solution is administered as one single dose for more than 2 hours of ischemia. No prospective randomized clinical study has compared the effects of HTK and cold blood Cardioplegia on myocardial damage in elective mitral valve surgery. Thus, the main aim of the present study was to examine whether one single dose of cold antegrade HTK gives as good myocardial protection as repetitive antegrade cold blood Cardioplegia in mitral valve surgery. Methods Eighty consecutive patients undergoing elective isolated mitral valve surgery for mitral regurgitation, with or without ablation for atrial fibrillation, were included in the study and randomized to HTK or blood Cardioplegia. Markers of myocardial injury (troponin-T and creatine kinase MB) were analyzed at baseline and 7 hours, 1 day, 2 days, and 3 days after surgery. Results No significant difference in creatine kinase MB and troponin-T between HTK and blood Cardioplegia groups was found at any time point. There was a significant correlation between ischemic time and markers of myocardial injury in the HTK group only and significantly more spontaneous ventricular fibrillation after release of crossclamping in the HTK group. Conclusions One single dose of antegrade cold HTK cardioplegic solution in elective mitral valve surgery protects the myocardium equally well as repetitive antegrade cold blood Cardioplegia.
-
One single dose of histidine–tryptophan–ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repetitive cold blood Cardioplegia: A prospective randomized study
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Bjorn Braathen, Anders Jeppsson, Henrik Schersten, Ole Magnus Hagen, Oystein Vengen, Helena Rexius, Vincenzo Lepore, Theis TønnessenAbstract:Objectives Histidine-tryptophan-ketoglutarate (HTK–Custodiol) cardioplegic solution is administered as one single dose for more than 2 hours of ischemia. No prospective randomized clinical study has compared the effects of HTK and cold blood Cardioplegia on myocardial damage in elective mitral valve surgery. Thus, the main aim of the present study was to examine whether one single dose of cold antegrade HTK gives as good myocardial protection as repetitive antegrade cold blood Cardioplegia in mitral valve surgery. Methods Eighty consecutive patients undergoing elective isolated mitral valve surgery for mitral regurgitation, with or without ablation for atrial fibrillation, were included in the study and randomized to HTK or blood Cardioplegia. Markers of myocardial injury (troponin-T and creatine kinase MB) were analyzed at baseline and 7 hours, 1 day, 2 days, and 3 days after surgery. Results No significant difference in creatine kinase MB and troponin-T between HTK and blood Cardioplegia groups was found at any time point. There was a significant correlation between ischemic time and markers of myocardial injury in the HTK group only and significantly more spontaneous ventricular fibrillation after release of crossclamping in the HTK group. Conclusions One single dose of antegrade cold HTK cardioplegic solution in elective mitral valve surgery protects the myocardium equally well as repetitive antegrade cold blood Cardioplegia.
-
cold blood Cardioplegia reduces the increase in cardiac enzyme levels compared with cold crystalloid Cardioplegia in patients undergoing aortic valve replacement for isolated aortic stenosis
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Bjorn Braathen, Theis TønnessenAbstract:Objectives Cardiac arrest during cardiac surgery is most commonly induced by cold blood or cold crystalloid Cardioplegia. The results from clinical studies are divergent regarding which of the 2 solutions provides better myocardial protection. This might be explained by several factors. Both heterogeneity in disease for the included patients and the fact that most studies are retrospective in design and that patients with coronary artery disease with different degrees of myocardial ischemia are included might explain these findings. To circumvent these potentially confounding factors, we included in a prospective randomized study only patients undergoing aortic valve replacement for aortic stenosis without other significant cardiac disease. Patients were randomized to antegrade cold crystalloid or cold blood Cardioplegia. Methods Eighty patients with aortic stenosis undergoing aortic valve replacement without significant coronary artery stenosis or other significant concomitant heart valve disease were included in the study. They were randomized to either antegrade cold blood or cold crystalloid cardioplegic solution delivered through the coronary ostia every 20 minutes throughout the period of aortic crossclamping. Maximum postoperative creatine kinase isoenzyme MB and troponin-T levels, well-established markers of myocardial damage, were compared between the 2 groups. Results Both maximum postoperative creatine kinase isoenzyme MB and troponin-T levels were significantly higher by approximately 100% in the cohort of patients receiving crystalloid compared with blood Cardioplegia. Only in the group of patients receiving cold crystalloid Cardioplegia was there a positive correlation between cardiac enzyme levels and crossclamp time. Conclusion Antegrade cold blood Cardioplegia provides better myocardial protection than cold crystalloid Cardioplegia in patients undergoing aortic valve replacement.
Theis Tønnessen - One of the best experts on this subject based on the ideXlab platform.
-
One single dose of histidine–tryptophan–ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repetitive cold blood Cardioplegia: A prospective randomized study
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Bjorn Braathen, Anders Jeppsson, Henrik Schersten, Ole Magnus Hagen, Oystein Vengen, Helena Rexius, Vincenzo Lepore, Theis TønnessenAbstract:Objectives Histidine-tryptophan-ketoglutarate (HTK–Custodiol) cardioplegic solution is administered as one single dose for more than 2 hours of ischemia. No prospective randomized clinical study has compared the effects of HTK and cold blood Cardioplegia on myocardial damage in elective mitral valve surgery. Thus, the main aim of the present study was to examine whether one single dose of cold antegrade HTK gives as good myocardial protection as repetitive antegrade cold blood Cardioplegia in mitral valve surgery. Methods Eighty consecutive patients undergoing elective isolated mitral valve surgery for mitral regurgitation, with or without ablation for atrial fibrillation, were included in the study and randomized to HTK or blood Cardioplegia. Markers of myocardial injury (troponin-T and creatine kinase MB) were analyzed at baseline and 7 hours, 1 day, 2 days, and 3 days after surgery. Results No significant difference in creatine kinase MB and troponin-T between HTK and blood Cardioplegia groups was found at any time point. There was a significant correlation between ischemic time and markers of myocardial injury in the HTK group only and significantly more spontaneous ventricular fibrillation after release of crossclamping in the HTK group. Conclusions One single dose of antegrade cold HTK cardioplegic solution in elective mitral valve surgery protects the myocardium equally well as repetitive antegrade cold blood Cardioplegia.
-
cold blood Cardioplegia reduces the increase in cardiac enzyme levels compared with cold crystalloid Cardioplegia in patients undergoing aortic valve replacement for isolated aortic stenosis
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Bjorn Braathen, Theis TønnessenAbstract:Objectives Cardiac arrest during cardiac surgery is most commonly induced by cold blood or cold crystalloid Cardioplegia. The results from clinical studies are divergent regarding which of the 2 solutions provides better myocardial protection. This might be explained by several factors. Both heterogeneity in disease for the included patients and the fact that most studies are retrospective in design and that patients with coronary artery disease with different degrees of myocardial ischemia are included might explain these findings. To circumvent these potentially confounding factors, we included in a prospective randomized study only patients undergoing aortic valve replacement for aortic stenosis without other significant cardiac disease. Patients were randomized to antegrade cold crystalloid or cold blood Cardioplegia. Methods Eighty patients with aortic stenosis undergoing aortic valve replacement without significant coronary artery stenosis or other significant concomitant heart valve disease were included in the study. They were randomized to either antegrade cold blood or cold crystalloid cardioplegic solution delivered through the coronary ostia every 20 minutes throughout the period of aortic crossclamping. Maximum postoperative creatine kinase isoenzyme MB and troponin-T levels, well-established markers of myocardial damage, were compared between the 2 groups. Results Both maximum postoperative creatine kinase isoenzyme MB and troponin-T levels were significantly higher by approximately 100% in the cohort of patients receiving crystalloid compared with blood Cardioplegia. Only in the group of patients receiving cold crystalloid Cardioplegia was there a positive correlation between cardiac enzyme levels and crossclamp time. Conclusion Antegrade cold blood Cardioplegia provides better myocardial protection than cold crystalloid Cardioplegia in patients undergoing aortic valve replacement.
Hiroshi Matsuura - One of the best experts on this subject based on the ideXlab platform.
-
Warm versus cold blood Cardioplegia : is there a difference ?
The Journal of thoracic and cardiovascular surgery, 1993Co-Authors: Hiroshi Matsuura, Harold L. Lazar, Ximing Yang, Samuel Rivers, Patrick Treanor, Sheilah Bernard, Richard J. SheminAbstract:This experimental study sought to compare the effectiveness of warm blood Cardioplegia versus cold blood Cardioplegia in protecting areas of ischemic myocardium during urgent coronary revascularization. In 40 adult pigs, the second and third diagonal vessels were occluded with snares for 90 minutes. All animals were then placed on cardiopulmonary bypass and underwent 45 minutes of cardioplegic arrest followed by 3 hours of reperfusion during which time the coronary snares were released. During the period of cardioplegic arrest, 10 pigs received antegrade continuous warm blood cardioplegic solution (37° C) at 100 ml/min; 10 animals received retrograde warm blood cardioplegic solution at 100 ml/min; 10 received intermittent, antegrade cold blood cardioplegic solution (4° C), and 10 animals received intermittent, antegrade/retrograde cold blood cardioplegic solution. Hearts protected with antegrade warm blood cardioplegic solution had the lowest pH values in the area at risk (6.59 ± 0.10 antegrade warm blood Cardioplegia versus 6.80 ± 0.10 retrograde warm blood Cardioplegia versus 6.72 ± 0.18 antegrade cold blood Cardioplegia versus 6.85 ± 0.15 antegrade/retrograde cold blood Cardioplegia and the highest area of necrosis (42 % ± 3 % antegrade warm blood Cardioplegia versus 26% ± 2% [p
-
Detrimental effects of interrupting warm blood Cardioplegia during coronary revascularization.
The Journal of thoracic and cardiovascular surgery, 1993Co-Authors: Hiroshi Matsuura, Harold L. Lazar, Ximing Yang, Samuel Rivers, Patrick Treanor, Richard J. SheminAbstract:Warm blood Cardioplegia has emerged as a substitute for cold blood Cardioplegia as a method of myocardial protection. However, the continuous infusion of blood in this technique may obscure the operative field and necessitate interruption of warm blood Cardioplegia. This experimental study was therefore undertaken to determine whether interrupting warm blood Cardioplegia during coronary revascularization would increase myocardial damage. In 30 adult pigs, the second and third diagonal vessels were occluded with snares for 90 minutes. All animals underwent cardiopulmonary bypass and 45 minutes of cardioplegic arrest. During the period of cardioplegic arrest, 10 pigs received intermittent antegrade/retrograde infusion of cold blood cardioplegic solution (4 degrees C) 10 pigs received continuous retrograde infusion of warm blood cardioplegic solution (37 degrees C) at 100 ml/min, and 10 pigs received retrograde infusion of warm blood cardioplegic solution that was interrupted for three 7-minute periods. After aortic unclamping, the coronary snares were released and all hearts were reperfused for 180 minutes. Interrupting retrograde warm blood Cardioplegia resulted in more tissue acidosis during cardioplegic arrest (6.20 +/- 0.16 interrupted retrograde warm blood Cardioplegia and 6.45 +/- 0.12 continuous retrograde warm blood Cardioplegia, both p < 0.05 compared with 6.98 +/- 0.17 intermittent antegrade and retrograde cold blood Cardioplegia), decreased echocardiographic wall-motion scores (4 [normal] to -1 [dyskinesis]; 2.06 +/- 0.30 interrupted retrograde warm blood Cardioplegia, p < 0.05 compared with 3.30 +/- 0.40 intermittent antegrade and retrograde cold blood Cardioplegia, 2.80 +/- 0.40 continuous retrograde warm blood Cardioplegia), and increased tissue necrosis as measured by the area of necrosis/area at risk (38% +/- 5% interrupted retrograde warm blood Cardioplegia, p < 0.05 compared with 21% +/- 2% intermittent antegrade and retrograde cold blood Cardioplegia; 25% +/- 2% continuous retrograde warm blood Cardioplegia). We concluded that interrupting warm blood Cardioplegia during coronary revascularization diminishes the effectiveness of warm blood Cardioplegia and results in increased ischemic damage.
Donald A.g. Mickle - One of the best experts on this subject based on the ideXlab platform.
-
Antegrade and retrograde Cardioplegia: Alternate or simultaneous?
The Journal of thoracic and cardiovascular surgery, 1996Co-Authors: Toshizumi Shirai, J. S. Ikonomidis, Susan Carson, Molly K. Mohabeer, Richard D Weisel, Nobuhiko Hayashida, Joan Ivanov, Vivek Rao, Donald A.g. MickleAbstract:Abstract Neither antegrade nor retrograde cardioplegic protection provides homogeneous distribution, and a combination may be required to avoid anaerobic metabolism and depressed postoperative ventricular function. Tepid Cardioplegia (29° C) avoids the delayed recovery of cardiac function and metabolism associated with cold Cardioplegia (15° C) and reduces the anaerobic metabolism seen with warm (37° C) Cardioplegia. We compared two techniques that combine antegrade and retrograde tepid Cardioplegia: alternate and simultaneous. Methods: Sixty patients undergoing elective isolated coronary artery bypass grafting were randomized to receive near continuous tepid retrograde and either intermittent antegrade Cardioplegia (the alternate technique) or antegrade Cardioplegia with the solution delivered concurrently through each completed vein graft (the simultaneous technique). Results: Myocardial lactate extraction was greater after crossclamp release following simultaneous than alternate Cardioplegia. Postoperative ventricular function was better after alternate than simultaneous Cardioplegia. Conclusion: Both techniques permitted rapid postoperative recovery of myocardial metabolism and ventricular function. However, simultaneous Cardioplegia was simpler and did not require deairing the aortic root between antegrade infusions. (J THORAC CARDIOVASC SURG 1996;112:787-96)
-
Which techniques of Cardioplegia prevent ischemia
The Annals of thoracic surgery, 1993Co-Authors: Terrence M. Yau, J. S. Ikonomidis, Susan Carson, Molly K. Mohabeer, Richard D Weisel, Donald A.g. Mickle, Nobuhiko Hayashida, Joan Ivanov, L. C. TumiatiAbstract:Abstract One hundred seven patients undergoing coronary artery bypass grafting were randomized to receive warm antegrade (n = 21), warm retrograde (n = 22), cold antegrade (n = 20), cold retrograde (n = 22), or intermittent cold antegrade (n = 22) blood Cardioplegia. Myocardial oxygen consumption and lactate production, adenine nucleotides, and adenine nucleotide degradation products were measured during the operation, and creatine kinase-MB release was assessed postoperatively. Warm Cardioplegia resulted in greater myocardial lactate production than cold Cardioplegia ( p = 0.048). Retrograde Cardioplegia was associated with greater lactate production than antegrade caidioplegia ( p = 0.015). Adenosine triphosphate depletion was similar among groups. However, poorly diffusible metabolites of adenosine triphosphate accumulated to the greatest extent in the intermittent cold group. Levels of hypoxanthine were highest after warm retrograde Cardioplegia. Operative mortality and morbidity were low and were not different among groups. In summary, none of the five techniques of Cardioplegia evaluated in this study was able to completely prevent myocardial ischemia. Anaerobic lactate production was minimized with cold Cardioplegia and with antegrade cardioplegic delivery. Hypothermia may have impaired regeneration of adenosine triphosphate, however, particularly in association with inadequate or intermittent cardioplegic flow.
-
Alternative techniques of Cardioplegia.
Circulation, 1992Co-Authors: T M Yau, R. D. Weisel, Masashi Komeda, J. Ivanov, Molly K. Mohabeer, Donald A.g. Mickle, S Carson, L. C. TumiatiAbstract:Although normothermic Cardioplegia has been used with acceptable clinical results, no studies have previously been performed to determine the metabolic consequences of these various techniques of myocardial protection. Therefore, we have performed a randomized clinical trial to assess the effects of three cardioplegic techniques on myocardial metabolic recovery. Seventy-four patients undergoing coronary artery bypass graft surgery were randomized to receive normothermic antegrade blood Cardioplegia (n = 25), normothermic retrograde blood Cardioplegia (n = 23), or intermittent cold antegrade blood Cardioplegia (n = 26). Myocardial oxygen consumption and lactate production, adenine nucleotides, and adenine nucleotide degradation products were measured during the operation, and cardiac creatine kinase isoenzyme (CK-MB) release was assessed after surgery. Warm antegrade Cardioplegia maximized myocardial oxygen consumption during cardioplegic delivery. Postoperative CK-MB release was less after warm antegrade Cardioplegia, but the difference was not statistically significant. Warm retrograde Cardioplegia resulted in the greatest degree of anaerobic lactate production but did not increase morbidity and mortality. Perioperative myocardial infarctions and postoperative low-output syndrome were most common after cold Cardioplegia, but this trend was not statistically significant. During warm antegrade Cardioplegia, adenosine triphosphate (ATP) was metabolized to diffusible precursors, which were washed out during cardioplegic infusion. Warm retrograde Cardioplegia produced a breakdown of ATP to inosine and hypoxanthine, small molecules that accumulated during the cross-clamp period and were not washed out, perhaps because of inadequate perfusion with retrograde delivery. During cold Cardioplegia, ATP was dephosphorylated, and adenosine diphosphate, adenosine monophosphate, and adenosine accumulated. These compounds were not regenerated to ATP but were not washed out of myocytes because they are large anionic molecules. Intermittent cold Cardioplegia inhibited mitochondrial function but prevented the degradation of adenine nucleotides. Warm antegrade Cardioplegia had the greatest myocardial oxygen consumption, and warm retrograde Cardioplegia had the greatest anaerobic lactate production. There were no differences in clinical outcomes between cardioplegic groups.