title: St. Thomas' Hospital cardioplegia: enhanced protection with exogenous creatine phosphate.
abstract: BACKGROUND
  Experimentally, creatine phosphate (CP) improves postischemic recovery of function and reduces postischemic arrhythmias.
  
  
  METHODS
  We studied 50 patients undergoing valve replacement. They were randomized into either a control group, who received St. Thomas' Hospital cardioplegic solution No. 1, or a CP-treated group, receiving the same cardioplegic solution plus CP (10 mmol/L). There were no preoperative clinical differences between groups. Assessment was by electrocardiographic analysis, inotropic drug requirement, quantitative birefringence, myocardial high-energy phosphate content, function, and semiquantitative ultrastructural assessment.
  
  
  RESULTS
  Direct-current shocks were reduced in the CP-treated group (0.88 +/- 0.15) compared with the control group (1.40 +/- 0.14; p < 0.02), as was the total number of joules (22.0 +/- 3.5 versus 34.4 +/- 3.7, respectively; p <0.02). The incidence of spontaneous sinus rhythm was higher in the CP-treated group (40% versus 8%; p < 0.05) and the incidence of postoperative arrhythmias, lower (8% versus 32%; p < 0.05). Prolonged inotropic administration (12 hours or longer) occurred in fewer patients in the CP-treated group (4% versus 28%; p < 0.05). Response to inotropic support (in the subset of patients requiring this treatment) was significantly greater in the CP-treated group than in the control group. There were no differences in recovery of function, birefringence changes, myocardial high-energy phosphate content, or ultrastructure between groups.
  
  
  CONCLUSIONS
  St. Thomas' Hospital cardioplegic solution No. 1 plus CP enhanced myocardial protection and conferred a direct benefit to the patient by reducing postoperative arrhythmias and need of prolonged inotropic support.
authors.affiliation: Cardiac Surgical Research, Rayne Institute, St. Thomas' Hospital, London, United Kingdom.
authors.forename: D J
authors.initials: DJ
authors.lastname: Chambers
authors.forename: K
authors.initials: K
authors.lastname: Haire
authors.forename: N
authors.initials: N
authors.lastname: Morley
authors.forename: L
authors.initials: L
authors.lastname: Fairbanks
authors.forename: E
authors.initials: E
authors.lastname: Strumia
authors.forename: C P
authors.initials: CP
authors.lastname: Young
authors.forename: G E
authors.initials: GE
authors.lastname: Venn
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001639:Bicarbonates; D001707:Biopsy, Needle; D002122:Calcium Chloride; D002314:Cardioplegic Solutions; D002316:Cardiotonic Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D004562:Electrocardiography; D004734:Energy Metabolism; D005260:Female; D006321:Heart / Q000503:physiopathology; D006350:Heart Valve Prosthesis; D006351:Heart Valves / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D008274:Magnesium; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D010725:Phosphocreatine; D011182:Postoperative Care; D011183:Postoperative Complications; D011189:Potassium Chloride; D012965:Sodium Chloride
chemical_list: D001639:Bicarbonates; D002314:Cardioplegic Solutions; D002316:Cardiotonic Agents; C041711:St. Thomas' Hospital cardioplegic solution; D010725:Phosphocreatine; D012965:Sodium Chloride; D011189:Potassium Chloride; D008274:Magnesium; D002122:Calcium Chloride