Myocardial cooling with ice-slush provides no cardioprotective effects in aortic valve replacement.
OBJECTIVE
Topical cooling of the heart with ice-slush has been widely used for myocardial protection. No prospective, randomized study has evaluated the effect of ice-slush on acknowledged markers (CK-MB, troponin-T) of myocardial damage during aortic valve replacement (AVR). This was the first aim of the present study. A second aim was to examine whether performing a study per se reduced myocardial damage.


METHODS
Sixty patients undergoing AVR were receiving cold crystalloid antegrade cardioplegia every 20 min. Thirty patients were randomized to achieve additional topical cooling with ice-slush. CK-MB and troponin-T were compared between groups as well as to a group of patients undergoing AVR immediately prior to the study.


RESULTS
There were no significant differences in myocardial markers between patients with or without ice-slush. However, we found significantly higher levels of troponin-T and CK-MB in patients undergoing AVR prior to start of the study.


CONCLUSIONS
Topical cooling with ice-slush does not provide additional cardioprotective effects. Comparison with an historical cohort indicates that administration of crystalloid cardioplegia following a rigid protocol might reduce myocardial damage.
Braathen
Bjørn
B
Department of Cardiothoracic Surgery, Ullevål University Hospital, Oslo, Norway.
Vengen
Oystein A
OA
Tønnessen
Theis
T
D000368:Aged; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002314:Cardioplegic Solutions; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007053:Ice; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011184:Postoperative Period; D017680:Potassium Compounds; D011446:Prospective Studies; D013997:Time Factors; D020107:Troponin T / Q000097:blood
D002314:Cardioplegic Solutions; D007053:Ice; D017680:Potassium Compounds; D020107:Troponin T; C018369:potassium cardioplegic solution; D052279:Creatine Kinase, MB Form