Cold blood cardioplegia reduces the increase in cardiac enzyme levels compared with cold crystalloid cardioplegia in patients undergoing aortic valve replacement for isolated aortic stenosis.
OBJECTIVE
Cardiac arrest during cardiac surgery is most commonly induced by cold blood or cold crystalloid cardioplegia. The results from clinical studies are divergent regarding which of the 2 solutions provides better myocardial protection. This might be explained by several factors. Both heterogeneity in disease for the included patients and the fact that most studies are retrospective in design and that patients with coronary artery disease with different degrees of myocardial ischemia are included might explain these findings. To circumvent these potentially confounding factors, we included in a prospective randomized study only patients undergoing aortic valve replacement for aortic stenosis without other significant cardiac disease. Patients were randomized to antegrade cold crystalloid or cold blood cardioplegia.


METHODS
Eighty patients with aortic stenosis undergoing aortic valve replacement without significant coronary artery stenosis or other significant concomitant heart valve disease were included in the study. They were randomized to either antegrade cold blood or cold crystalloid cardioplegic solution delivered through the coronary ostia every 20 minutes throughout the period of aortic crossclamping. Maximum postoperative creatine kinase isoenzyme MB and troponin-T levels, well-established markers of myocardial damage, were compared between the 2 groups.


RESULTS
Both maximum postoperative creatine kinase isoenzyme MB and troponin-T levels were significantly higher by approximately 100% in the cohort of patients receiving crystalloid compared with blood cardioplegia. Only in the group of patients receiving cold crystalloid cardioplegia was there a positive correlation between cardiac enzyme levels and crossclamp time.


CONCLUSIONS
Antegrade cold blood cardioplegia provides better myocardial protection than cold crystalloid cardioplegia in patients undergoing aortic valve replacement.
Braathen
Bjørn
B
Department of Cardiothoracic Surgery, Ullevål University Hospital, University of Oslo, and Center for Heart Failure Research, Oslo, Norway.
Tønnessen
Theis
T
D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000097:blood / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion; D002314:Cardioplegic Solutions / Q000494:pharmacology*; D003080:Cold Temperature; D052279:Creatine Kinase, MB Form / Q000097:blood; D000077324:Crystalloid Solutions; D005260:Female; D006321:Heart / Q000187:drug effects*; D006324:Heart Arrest, Induced / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced; D007552:Isotonic Solutions / Q000494:pharmacology; D008297:Male; D009206:Myocardium / Q000201:enzymology; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D020107:Troponin T; D052279:Creatine Kinase, MB Form