Intraoperative myocardial protection with extracellular cardioplegic solutions in patients with cardiac valve diseases

• Published in: Anesteziologiia i reanimatologiia no. 2; p. 38
• Main Authors: Zhidkov, I L, Ivanov, V A, Kozhevnikov, V A, Charnaia, M A, Mukhamedzianova, A R, Trekova, N A
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 01.03.2007
• Subjects: Aged; Blood Circulation - drug effects; Cardioplegic Solutions - administration & dosage; Cardiotonic Agents - administration & dosage; Coronary Circulation - drug effects; Extracorporeal Circulation - adverse effects; Female; Heart - drug effects; Heart Valve Diseases - surgery; Humans; Intraoperative Care; Isotonic Solutions - administration & dosage; Male; Middle Aged; Myocardium
• ISSN: 0201-7563

A hundred patients operated on under extracorporeal circulation (EC) with bicaval cannulation in the moderate general hypothermia mode were intraoperatively examined. According to the used cardioplegic solution, all the patients were divided into three groups: 1) Konsol; 2) Konsol MF; 3) St. Thomas (a control group). All the groups were matched by age, gender, the duration of myocardial ischemia (MI) (37-128 min), that of EC (52-186 min), and the nature of surgical interventions, of which mitral valve replacement amounted to 72-78%. To prepare a modified solution, 20 ml of 40% glucose, 20 units of insulin, and 200 mg of creatine phosphate (Neoton) were added to a flask containing 400 ml of Konsol. The efficiency of myocardial protection was evaluated by the data characterizing cardiac arrest and cardiac performance resumption, as well as by heart rate and the use of inotropic support in the reperfusion period. The parameters of central hemodynamics and systemic coronary blood flow, the concentrations of glucose and lactate, the blood gas and electrolyte composition of the coronary sinus (CS), myocardial oxygen consumption and the oxygen-utilizing coefficient were monitored. The cardioplegic solutions Consol and Consol MF were found to have a more effective cardioprotective activity in patients with cardiac valvular disease, operated on under EC and moderate hypothermia that St. Thomas'solution. Modification of the Consol solution by adding glucose, creatine phosphate, and insulin improves the protective effect of the solution, promoting a rapider transition of the myocardium from anaerobic to aerobic metabolism.