Blood warm reperfusion: a necessary adjunct to heart-valve surgery in low-risk patients?
OBJECTIVE
The aim of this prospective, randomized study was to determine whether blood warm reperfusion improves myocardial protection provided by cold crystalloid cardioplegia in patients undergoing first-time elective heart-valve surgery, using cardiac troponin I release as the criterion for evaluating the adequacy of myocardial protection.


METHODS
Seventy patients with a left ventricular ejection fraction greater than 40% were randomly assigned to 1 of 2 myocardial protection strategies: 1) cold crystalloid cardioplegia with no reperfusion or 2) cold crystalloid cardioplegia followed by 2-minute blood warm reperfusion before aortic unclamping. Cardiac troponin I concentrations were measured in serial venous blood samples drawn immediately prior to cardiopulmonary bypass and after aortic unclamping at 6, 9, 12, and 24 h.


RESULTS
Randomization produced 2 equivalent groups. The total amount of cardiac troponin I released (7.17+/- 14.8 mg in the crystalloid cardioplegia with no reperfusion group and 5.82+/-4.66 mg in the crystalloid cardioplegia followed by blood warm reperfusion group) was not different (P > 0.2). Cardiac troponin I concentration did not differ for any sample in either of the 2 groups. The total amount of cardiac troponin I released was higher in patients who required inotropic support (9.14 +/-16.2 mg) than those who did not (4.73+/-4.52 mg; P = 0.009).


CONCLUSIONS
Our study shows that adding blood warm reperfusion to cold crystalloid cardioplegia provides no additional myocardial protection in low-risk patients undergoing heart-valve surgery.
Falcoz
P E
PE
Department of Thoracic and Cardiovascular Surgery Hôpital Jean-Minjoz, Besançon, France. pierre-emmanuel.falcoz@wanadoo.fr
Kaili
D
D
Chocron
S
S
Stoica
L
L
Toubin
G
G
Puyraveau
M
M
Viel
J F
JF
Etievent
J P
JP
D000368:Aged; D005260:Female; D006324:Heart Arrest, Induced; D006349:Heart Valve Diseases / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods*; D009206:Myocardium / Q000378:metabolism*; D017680:Potassium Compounds; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D018570:Risk Assessment; D013696:Temperature; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*
D017680:Potassium Compounds; D019210:Troponin I; C018369:potassium cardioplegic solution