Comparison of three strategies for myocardial protection during coronary artery bypass graft surgery based on markers of cardiac damage.
OBJECTIVE
To evaluate myocardial damage during coronary artery bypass grafting using three different intermittent cardioplegia and then measuring cTnI and CKMBm release.


METHODS
Forty-two patients belonging to the hypothermic crystalloid (n = 16), hypothermic (n = 13), and normothermic blood (n = 13) groups were collected when removing the aortic cross-clamp (t = 0) and after 4, 12, 24 and 48 h. For each patient, cumulative cTnI and CKMBm release was calculated as the five measurement mean. There were no significant preoperative and operative differences in the three groups.


RESULTS
In the normothermic group, cTnI mean values at 4, 12, and 24 h were significantly lower than those in both hypothermic groups; moreover, CKMBm mean values were higher at 4, 12, and 24 h in the hypothermic crystalloid group and at 4 and 12 h in the hypothermic blood group than in the normothermic group. In the normothermic group, the area under the curve of the release of both markers was significantly lower than in the hypothermic groups. No significant difference was reported in the release of both markers in hypothermic groups.


CONCLUSIONS
A strategy of normothermic cardioplegia seems to preserve myocardium better than hypothermic cardioplegia.
Barassi
Alessandra
A
Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università degli Studi dell'Insubria, RAISE, Varese, Italy. alessandra.barassi@tin.it
Merlini
Giampaolo
G
Finazzi
Sergio
S
Pallotti
Francesco
F
Mantovani
Vittorio
V
Sala
Andrea
A
d'Eril
Gianvico Melzi
GM
D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002314:Cardioplegic Solutions / Q000008:administration & dosage; D003080:Cold Temperature; D001026:Coronary Artery Bypass / Q000379:methods*; D003402:Creatine Kinase / Q000097:blood; D000077324:Crystalloid Solutions; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced; D007552:Isotonic Solutions; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D009206:Myocardium / Q000378:metabolism; D010952:Plasma Substitutes; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D019210:Troponin I; D003402:Creatine Kinase