A controlled trial of substrate-enhanced, warm reperfusion ("hot shot") versus simple reperfusion.
BACKGROUND
Modified reperfusion after aortic cross-clamping is claimed to reduce myocardial injury, thus improving postoperative myocardial performance.


METHODS
We measured perioperative release of creatine kinase-MB and troponin-T in 40 patients undergoing valve replacement (combined with coronary grafts in 12 cases) to determine whether infusion of a modified reperfusate before cross-clamp removal reduced myocardial injury. Patients were randomly allocated to one of two groups with minimization for age, surgeon, operation, and ventricular function. The control group received unmodified reperfusion, while the study group received a normothermic reperfusate, enhanced with glutamate and aspartate, for 5 minutes before removal of the cross-clamp. Serial determinations of troponin-T, creatine kinase-MB isoforms, and total creatine kinase-MB activity were made up to 5 days postoperatively. Requirements for inotropic support and evidence of myocardial infarction were documented.


RESULTS
Creatine kinase-MB activity, creatine kinase-MB isoforms, and troponin-T were not significantly different between the two groups. There were no differences in the incidence of postoperative myocardial infarction or in inotrope requirement.


CONCLUSIONS
Our study did not demonstrate any advantage in using modified reperfusion in this group of patients.
Edwards
R
R
Department of Cardiological Sciences, St. George's Hospital Medical School, London, England.
Treasure
T
T
Hossein-Nia
M
M
Murday
A
A
Kantidakis
G H
GH
Holt
D W
DW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003402:Creatine Kinase / Q000097:blood; D006324:Heart Arrest, Induced; D006801:Humans; D007527:Isoenzymes; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D015424:Reperfusion / Q000379:methods*; D020107:Troponin T / Q000032:analysis
D007527:Isoenzymes; D020107:Troponin T; D003402:Creatine Kinase