title: Initial large-dose administration of modified St. Thomas' solution.
abstract: BACKGROUND
  We introduced an initial large dose of modified St. Thomas' Hospital cardioplegic solution with the aim of providing both myocardial protection as well as a smooth intraoperative process.
  
  
  METHODS
  In 90 cases of isolated aortic valve replacement, we used the modified technique of cardioplegia in 45 (group S) and conventional administration of glucose-insulin-potassium solution in 45 (group G). The patients were selected at random. In group S, we added 4 mEq of potassium to the original St. Thomas' Hospital solution and administered 30 mL·kg(-1) as an initial dose. The temperature was decreased to 2.
  
  
  RESULTS
  The mean of reperfusion time after declamping in group S was significantly shorter (16.7 ± 6.4 vs. 21.5 ± 10.0 min; p = 0.007). The average of postoperative maximum creatine kinase-MB was significantly lower in group S (25.6 ± 9.5 vs. 40.6 ± 37.2 IU·L(-1); p = 0.014). On multivariate analysis, use of the modified cardioplegia and aortic crossclamp time were significantly associated with creatine kinase-MB level and reperfusion time after declamping.
  
  
  CONCLUSIONS
  This modified technique was an acceptable option that provided a bloodless operative field and avoided multiple cardioplegic administrations.
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Arudo
authors.initials: A
authors.lastname: Hiraoka
authors.forename: Kosuke
authors.initials: K
authors.lastname: Nakajima
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kuinose
authors.forename: Toshinori
authors.initials: T
authors.lastname: Totsugawa
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yoshitaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001639:Bicarbonates / Q000008:administration & dosage / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D002122:Calcium Chloride / Q000008:administration & dosage / Q000009:adverse effects; D002314:Cardioplegic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D007564:Japan; D008274:Magnesium / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011189:Potassium Chloride / Q000008:administration & dosage / Q000009:adverse effects; D012965:Sodium Chloride / Q000008:administration & dosage / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001639:Bicarbonates; D015415:Biomarkers; D002314:Cardioplegic Solutions; C041711:St. Thomas' Hospital cardioplegic solution; D012965:Sodium Chloride; D011189:Potassium Chloride; D052279:Creatine Kinase, MB Form; D008274:Magnesium; D002122:Calcium Chloride
keywords: Aortic valve; St. Thomas' Hospital cardioplegic solution; cardiopulmonary bypass; glucose-insulin-potassium cardioplegic solution; heart arrest; induced