Gradual Reperfusion in Cardioplegia-Induced Cardiac Arrest
<i>Background and Objectives</i>: The majority of cardiac surgical procedures are performed using cardiopulmonary bypass and cardioplegia-induced cardiac arrest. Cardiac arrest and reperfusion may lead to ischemia-reperfusion injury of the myocardium. The aim of this study was to investi...
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MDPI AG
2024-09-01
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| Online Access: | https://www.mdpi.com/1648-9144/60/10/1564 |
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| author | Mascha von Zeppelin Florian Hecker Harald Keller Jan Hlavicka Thomas Walther Anton Moritz Mani Arsalan Tomas Holubec |
| author_facet | Mascha von Zeppelin Florian Hecker Harald Keller Jan Hlavicka Thomas Walther Anton Moritz Mani Arsalan Tomas Holubec |
| author_sort | Mascha von Zeppelin |
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| description | <i>Background and Objectives</i>: The majority of cardiac surgical procedures are performed using cardiopulmonary bypass and cardioplegia-induced cardiac arrest. Cardiac arrest and reperfusion may lead to ischemia-reperfusion injury of the myocardium. The aim of this study was to investigate whether gradual reperfusion with a slow increase in oxygen partial pressure leads to a reduction in reperfusion injury. <i>Materials and Methods</i>: Fifty patients undergoing elective cardiac surgery were included in this prospective randomized study. Patients in the hyperoxemic (control) group received conventional reoxygenation (paO<sub>2</sub> 250–300 mmHg). Patients in the normoxemic (study) group received gradual reoxygenation (1st-minute venous blood with paO<sub>2</sub> 30–40 mmHg, 2nd-minute arterial blood with paO<sub>2</sub> 100–150 mmHg). Periprocedural blood samples were taken serially, and markers of myocardial injury were analyzed. In addition, the influence of gradual reoxygenation on hemodynamics, inflammation, and the overall perioperative course was evaluated. <i>Results</i>: There was a trend toward higher CK levels in the hyperoxemia group without statistical significance; however, CK-MB and troponin T levels did not show any statistical difference between the two groups. Potassium concentrations in the coronary sinus were significantly higher in the hyperoxemia group at 3 and 8 min after opening of the aortic cross-clamp (6.88 ± 0.87 mmol/L vs. 6.30 ± 0.91 mmol/L and 5.87 ± 0.73 mmol/L vs. 5.43 ± 0.42 mmol/L, respectively; <i>p</i> = 0.03 and <i>p</i> = 0.02). All other measurements did not show a statistical difference between the two groups. <i>Conclusions</i>: The use of gradual reperfusion in cardiac surgery with cardiopulmonary bypass and cardiac arrest is safe. However, it does not reduce ischemia-reperfusion injury compared to standard hyperoxemic reperfusion. |
| format | Article |
| id | doaj-art-60c4fa2e949a4ddeb970dadd9fd41bee |
| institution | OA Journals |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj-art-60c4fa2e949a4ddeb970dadd9fd41bee2025-08-20T02:10:56ZengMDPI AGMedicina1010-660X1648-91442024-09-016010156410.3390/medicina60101564Gradual Reperfusion in Cardioplegia-Induced Cardiac ArrestMascha von Zeppelin0Florian Hecker1Harald Keller2Jan Hlavicka3Thomas Walther4Anton Moritz5Mani Arsalan6Tomas Holubec7Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, GermanyDepartment of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, GermanyDepartment of Cardiovascular Surgery, Clinical Perfusion, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, GermanyDepartment of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, GermanyDepartment of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, GermanyDepartment of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, GermanyDepartment of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, GermanyDepartment of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany<i>Background and Objectives</i>: The majority of cardiac surgical procedures are performed using cardiopulmonary bypass and cardioplegia-induced cardiac arrest. Cardiac arrest and reperfusion may lead to ischemia-reperfusion injury of the myocardium. The aim of this study was to investigate whether gradual reperfusion with a slow increase in oxygen partial pressure leads to a reduction in reperfusion injury. <i>Materials and Methods</i>: Fifty patients undergoing elective cardiac surgery were included in this prospective randomized study. Patients in the hyperoxemic (control) group received conventional reoxygenation (paO<sub>2</sub> 250–300 mmHg). Patients in the normoxemic (study) group received gradual reoxygenation (1st-minute venous blood with paO<sub>2</sub> 30–40 mmHg, 2nd-minute arterial blood with paO<sub>2</sub> 100–150 mmHg). Periprocedural blood samples were taken serially, and markers of myocardial injury were analyzed. In addition, the influence of gradual reoxygenation on hemodynamics, inflammation, and the overall perioperative course was evaluated. <i>Results</i>: There was a trend toward higher CK levels in the hyperoxemia group without statistical significance; however, CK-MB and troponin T levels did not show any statistical difference between the two groups. Potassium concentrations in the coronary sinus were significantly higher in the hyperoxemia group at 3 and 8 min after opening of the aortic cross-clamp (6.88 ± 0.87 mmol/L vs. 6.30 ± 0.91 mmol/L and 5.87 ± 0.73 mmol/L vs. 5.43 ± 0.42 mmol/L, respectively; <i>p</i> = 0.03 and <i>p</i> = 0.02). All other measurements did not show a statistical difference between the two groups. <i>Conclusions</i>: The use of gradual reperfusion in cardiac surgery with cardiopulmonary bypass and cardiac arrest is safe. However, it does not reduce ischemia-reperfusion injury compared to standard hyperoxemic reperfusion.https://www.mdpi.com/1648-9144/60/10/1564cardiac surgerycardioplegia-induced cardiac arrestischemia-reperfusion injurygradual reperfusionhyperoxemianormoxemia |
| spellingShingle | Mascha von Zeppelin Florian Hecker Harald Keller Jan Hlavicka Thomas Walther Anton Moritz Mani Arsalan Tomas Holubec Gradual Reperfusion in Cardioplegia-Induced Cardiac Arrest Medicina cardiac surgery cardioplegia-induced cardiac arrest ischemia-reperfusion injury gradual reperfusion hyperoxemia normoxemia |
| title | Gradual Reperfusion in Cardioplegia-Induced Cardiac Arrest |
| title_full | Gradual Reperfusion in Cardioplegia-Induced Cardiac Arrest |
| title_fullStr | Gradual Reperfusion in Cardioplegia-Induced Cardiac Arrest |
| title_full_unstemmed | Gradual Reperfusion in Cardioplegia-Induced Cardiac Arrest |
| title_short | Gradual Reperfusion in Cardioplegia-Induced Cardiac Arrest |
| title_sort | gradual reperfusion in cardioplegia induced cardiac arrest |
| topic | cardiac surgery cardioplegia-induced cardiac arrest ischemia-reperfusion injury gradual reperfusion hyperoxemia normoxemia |
| url | https://www.mdpi.com/1648-9144/60/10/1564 |
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