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Eur J Cardiothorac Surg 2002;21:440-446
© 2002 Elsevier Science NL
Bristol Heart Institute, University of Bristol, Bristol BS2 8HW, UK
Received 30 July 2001; received in revised form 12 December 2001; accepted 18 December 2001.
* Corresponding author. Tel.: +44-117-9283519; fax: +44-117-9299737
e-mail: m.s.suleiman{at}bristol.ac.uk
Objectives: Myocardial protection techniques during cardiac surgery have been largely investigated in the clinical setting of coronary revascularisation. Few studies have been carried out on patients with left ventricular hypertrophy where the choice of delivery, and temperature of cardioplegia remain controversial. This study investigates metabolic changes and myocardial injury in hypertrophic hearts of patients undergoing aortic valve surgery using antegrade cold or warm blood cardioplegia. Methods: Thirty-five patients were prospectively randomised to intermittent antegrade cold or warm blood cardioplegia. Left ventricular biopsies were collected at 5 min following institution of cardiopulmonary bypass, 30 min after cross-clamping the aorta and 20 min after cross-clamp removal, and used to determine metabolic changes during surgery. Metabolites (adenine nucleotides, amino acids and lactate) were measured using high pressure liquid chromatography and enzymatic techniques. Postoperative myocardial troponin I release was used as a marker of myocardial injury. Results: Ischaemic arrest was associated with significant increase in lactate and alanine/glutamate ratio only in the warm blood group. During reperfusion, alanine/glutamate ratio was higher than preischaemic levels in both groups, but the extent of the increase was considerably greater in the warm blood group. Troponin I release was markedly (P<0.05, Mean±SD) lower at 1, 24 and 48 h postoperatively in the cold compared to the warm blood group (0.51±0.37, 0.37±0.22 and 0.27±0.19 vs. 0.75±0.42, 0.73±0.51 and 0.54±0.38 ng/ml for cold vs. warm group, respectively). Conclusions: Cold blood cardioplegia is associated with less ischaemic stress and myocardial injury compared to warm blood cardioplegia in patients with aortic stenosis undergoing valve replacement surgery. Both cardioplegic techniques, however, confer sub-optimal myocardial protection.
Key Words: Ischaemia • Reperfusion • Valve (disease) • Hypertrophy • Energy metabolism
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