title: Comparison of standard (non-oxygenated) vs. oxygenated St. Thomas' Hospital cardioplegic solution No. 2 (Plegisol).
abstract: Recent studies have suggested that oxygenation of crystalloid cardioplegic solutions improves myocardial preservation. To assess whether oxygenation of St. Thomas' Hospital cardioplegic solution No. 2 (Plegisol) improves its clinical efficacy, 50 patients were randomly assigned into 2 groups: (1) those receiving Plegisol and (2) those receiving O2-Plegisol (PO2 greater than 500 mmHg at 4 degrees C). Efficacy was assessed by (a) clinical and haemodynamic parameters, (b) quantitative birefringence changes in response to ATP and calcium as a measurement of myocardial preservation in left and right ventricular biopsies, (c) creatine kinase (MB isoenzyme) release for up to 4 days postoperatively, (d) electrocardiographic (ECG) monitoring for up to 7 days postoperatively. There were no differences in mean age, ejection fraction, aortic cross-clamp duration, or bypass duration between the 2 groups of patients. In the Plegisol group, 2 patients (8%) died and 4 patients (16%) required inotropic support, whereas in the O2-Plegisol group there were no deaths and only 2 patients (8%) required inotropic support. These differences, however, were not statistically significant. Birefringence assessment demonstrated an improved myocardial response to ATP and calcium (predominantly in the left ventricular epimyocardium and in the right ventricular biopsies) at the end of ischaemia and after reperfusion in patients given O2-Plegisol. Deterioration in cellular assessment of myocardial contractility (measured by a reduction in birefringence of greater than 0.4 nm) was reduced from 20% in Plegisol patients to 12.5% in O2-Plegisol patients. CK-MB values showed no difference at any sampling time between the 2 groups of patients; a mean peak CK-MB of 35 IU/l occurred 2 h postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
authors: Cardiovascular Research (Surgical Cytochemistry), Rayne Institute, St. Thomas' Hospital, London, UK.
authors: D J
authors: DJ
authors: Chambers
authors: S
authors: S
authors: Kosker
authors: A
authors: A
authors: Takahashi
authors: A
authors: A
authors: Sakai
authors: S
authors: S
authors: Baharakakis
authors: G
authors: G
authors: Manzanera
authors: R A
authors: RA
authors: Jupp
authors: L D
authors: LD
authors: Smith
authors: M V
authors: MV
authors: Braimbridge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001639:Bicarbonates; D001706:Biopsy; D002122:Calcium Chloride; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D008274:Magnesium; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D010100:Oxygen; D011189:Potassium Chloride; D012965:Sodium Chloride
chemical_list: D001639:Bicarbonates; C041711:St. Thomas' Hospital cardioplegic solution; D012965:Sodium Chloride; D011189:Potassium Chloride; D003402:Creatine Kinase; D008274:Magnesium; D002122:Calcium Chloride; D010100:Oxygen