Creatine phosphate (Neoton) as an additive to St. Thomas' Hospital cardioplegic solution (Plegisol). Results of a clinical study.
Experimentally, creatine phosphate (CP) added to St. Thomas' Hospital cardioplegic solution (STH) improved post-ischaemic recovery of cardiac function in the rat heart. We investigated the effect of adding CP (10.0 mmol/l) to STH. Fifty open-heart surgery patients were randomized into control (STH) and treated (STH + CP) groups (25 per group). Patients underwent (a) monitoring for peri- and postoperative arrhythmias (48-h Holter monitoring). (b) quantitative birefringence assessment of intraoperative myocardial protection in left and right ventricular biopsies sampled at start of bypass (pre-isch.), end of bypass (end-isch.) and after 10 min reperfusion (post-isch.), and (c) measurement of serum creatine kinase-MB isozyme (CK-MB) values for up to 4 days postoperatively; results were assessed with respect to (d) haemodynamics and postoperative clinical outcome. Inotropic support (adrenaline) was required in three patients (12%) from each group; no patient died. All patients required defibrillation, and the number of direct current shocks required for sinus rhythm was the same in each group. The occurrence and incidence of reperfusion-induced arrhythmias were the same in both groups. Serum CK and CK-MB values were similar throughout the sampling period in both groups of patients; one patient in the control group had raised CK-MB levels postoperatively, but perioperative infarction was not indicated by the electrocardiogram.(ABSTRACT TRUNCATED AT 250 WORDS)
Chambers
D J
DJ
Cardiovascular Research (Surgical Cytochemistry), Rayne Institute, London.
Braimbridge
M V
MV
Kosker
S
S
Yamada
M
M
Jupp
R A
RA
Crowther
A
A
D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery; D001145:Arrhythmias, Cardiac / Q000517:prevention & control*; D001639:Bicarbonates / Q000008:administration & dosage / Q000627:therapeutic use; D002122:Calcium Chloride / Q000008:administration & dosage / Q000627:therapeutic use; D002314:Cardioplegic Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D006324:Heart Arrest, Induced / Q000379:methods; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D007527:Isoenzymes; D008274:Magnesium / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D009206:Myocardium / Q000473:pathology; D010725:Phosphocreatine / Q000008:administration & dosage / Q000627:therapeutic use*; D011189:Potassium Chloride / Q000008:administration & dosage / Q000627:therapeutic use; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors
D001639:Bicarbonates; D002314:Cardioplegic Solutions; D007527:Isoenzymes; C041711:St. Thomas' Hospital cardioplegic solution; D010725:Phosphocreatine; D012965:Sodium Chloride; D011189:Potassium Chloride; D003402:Creatine Kinase; D008274:Magnesium; D002122:Calcium Chloride