cardioplegia | Acta Medica Marisiensis

Left Ventricular Function and Morphology after Cardiac Surgery for Severe Mitral Insufficiency – A Single Center Experience

Carmen Opris¹, Horatiu Suciu², Septimiu Voidazan³, Cosmin Opris¹, Marius Harpa², Alexandra Stoica¹

1. Department of Adult and Children Cardiovascular Recovery, Emergency Institute for Cardio-Vascular Diseases and Transplantation, Targu Mures, Romania
2. Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Departament of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2020-0015

Introduction: Mitral insufficiency is a common valvular disease affecting 10% of the general population. The main treatment of the severe mitral regurgitation is surgical. We have analyzed the impact of cardiac surgery on the left ventricular performance and morphology, in patients treated for severe mitral insufficiency accordingly to the type of intervention, ischemic time and type of cardioplegia.
Methods: Ninety patients diagnosed with isolated severe mitral insufficiency that benefited from mitral valvular replacement or mitral valvuloplasty were retrospectively enrolled. The left ventricle, the left atrium, the right ventricle diameters and the left ventricle ejection fraction were measured by two-dimensional (2D) echocardiography before and after surgery. The influence of the myocardial ischemia time and the type of cardioplegia administered on the ventricular systolic function were also analyzed.
Results: Regardless the surgical technique chosen, after surgery we noticed a decreased size of the left ventricle (preoperative mean 54.91mm ±8.18 vs postoperative mean 51.94mm±8.15, p=0.035), right ventricle (preoperative mean 33.49mm±5,87 vs postoperative mean 32.41mm±6.03, p=0.0001), as well as the ejection fraction (preoperative mean 51.29%±8.51 vs postoperative mean 46.57%±8.71, p=0.0001).
Conclusions: Immediately after surgery, a decrease in the size of cardiac cavities as well as a decrease of the left ventricle ejection fraction is noticed.

Improved Cardiac Protection with Sabax Cardioplegia in Langendorff Isolated Rat Hearts

Perian M^1*, Mărginean M¹, Dobreanu D^1,2, Scridon Alina¹

1 Physiology Department, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Adults Cardiology Department (I), Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0004

Objective: Cardioplegia is an important step to facilitate cardiac surgery while limiting intraoperative myocardial injury. Although recent advances in cardioplegic arrest methods have significantly contributed to better postoperative outcomes, there is still controversy regarding the optimal composition and temperature of the cardioplegic solution. Accordingly, we aimed to assess whether cold or lukewarm Sabax cardioplegia offer improved myocardial protection compared with the classical Krebs-Henseleit solution.
Methods: The hearts of 40 male Wistar rats were isolated and submitted to constant-flow retrograde perfusion using a Langendorff perfusion apparatus. The hearts were randomly assigned to cold Krebs-Henseleit (K-H), cold Sabax, or lukewarm Sabax cardioplegia. The ECG, heart rates, and left ventricular systolic pressures (LVSP) were recorded pre- and post-cardioplegia. The time needed for cardioplegia induction and post-cardioplegia recovery were also noted.
Results: Both cold and lukewarm Sabax cardioplegia insured faster induction and faster recovery following isothermic reperfusion compared to the standard K-H solution (both p< 0.01). With K-H cardioplegia, the hearts presented a 21.7% force loss after reperfusion (p< 0.001), whilst Sabax cardioplegia was associated with a slight increase in ventricular mechanical activity (3% LVSP increase with lukewarm Sabax cardioplegia, p< 0.001 and 2% LVSP increase with cold Sabax cardioplegia, p = 0.02). With Sabax cardioplegia the hearts displayed considerably less major arrhythmic events and presented less significant bradycardia.
Conclusions: The present data suggest that Sabax cardioplegia may be superior to the classical cold crystalloid K-H solution in preserving mechanical activity of the heart and may provide superior protection against major arrhythmias.