Objective To summarize the experiences of donor heart procurement of heart transplantation so as to improve the efficiency of donor heart protection. [WTHZ]Methods [WTBZ]From April 2002 to October 2006, sixtyone patients with endstage heart disease had undergone orthotopic heart transplantation. Donors were all male brain deaths, aged from 21 to 53, and 5 of them were older than 40. There were 6 cases in which the weight difference between donor and recipient＞20%, and the rest ≤±20%. Fortyfive cases had the same ABO blood type, and 16 had matching ABO blood type. Four donor hearts were procured under the condition of stable hemodynamics and enough oxygen after brain death(typeⅠ), fortyfour donor hearts were procured under the condition of brain death with acute hemorrhage and hypovolemia (typeⅡ), and 13 donor hearts were procured under the condition of brain death with cardiac arrest (typeⅢ). Twenty cases underwent standard transplantation procedure, one underwent total heart transplantation procedure and 40 underwent bicaval transplantation procedure. The donor heart cold ischemic period ranged from 52 to 347 min（92±31 min）, and 13 cases were more than 240 min. Results Two cases died of low cardiac output syndrome on 7th and 9th day after operation respectively, and their donor heart cold ischemic period were 327 and 293 min respectively. The rest of patients all recovered and discharged. One died of acute rejection on 18th month after operation because of rejecting immunosuppressive agents, and 1 died in traffic accident on 23rd month after transplantation. The rest 57 cases survived 6-59 months(mean 35 months), and had good life quality with NYHA cardiac function classification in 0-I grade. Conclusions Heart transplantation with donor aged over 40 may also have satisfactory results. Patients with endstage dilated cardiomyopathy can procure donor heartsfrom donors with heavy weight. Using different techniques to procure donor hearts may furthest reduce myocardial injury. Donor hearts which have been protected by myocardium protecting liquid for a long time should be used with caution.
Objective To systematically review the influence of tight heart rate (HR) control on the efficacy of perioperative β-blockade, and discuss the effective measures of perioperative myocardial protection. Methods We searched the PubMed, OVID, EMbase, the Cochrane Library and Chinese Biomedical Database (CBM) for randomized controlled trials on evaluating perioperative β-blockers after noncardiac surgery. The quality of the included studies was evaluated by the method recommended by the Cochrane Collaboration. Meta-analyses was conducted by using the Cochrane Collaboration’s RevMan software. Results Thirteen RCTs including 11 590 patients were included. The combined results of all studies showed cardioprotective effect of β-blockers (OR=0.64, 95%CI 0.50 to 0.80, P=0.000 1), with considerable heterogeneity among the studies (I2=57%). However, grouping the trials on the basis of maximal HR showed that trials where the estimated maximal HR was 100 bpm were associated with cardioprotection (OR=0.37, 95%CI 0.26 to 0.52, Plt;0.000 01) whereas trials where the estimated maximal HR was 100 bpm did not demonstrate cardioprotection (OR=1.13, 95%CI 0.81 to 1.59, P=0.48) with no heterogeneity (I2=0%). Conclusion The evidence suggests that effective control of HR is important for achieving cardioprotection and that administration of β-blockers does not reliably decrease HRs in all patients. Judicious use of combination therapy with other drugs may be necessary to achieve effective postoperative control of HR.
Objective To investigate the myocardial protective effects of Del Nido cardioplegia and analyze its advantages in adult cardiac surgery. Methods We retrospectively analyzed the clinical data of 96 adult patients undergoing cardiac valve surgery who received Del Nido cardioplegia (a DNC group) from June 2016 to January 2017 in our hospital. There were 44 males and 52 females with a mean age of 51.36±13.31 years. Meanwhile 96 patients who received conventional cardioplegia were recruited as a control group (a CTC group) and there were 53 males and 43 females with a mean age of 52.91±10.95 years. Cross-clamping time, cardiopulmonary bypass (CPB) time, total volume of and transfusion frequency of cardioplegia, the rate of spontaneous defibrillation, red blood cell transfusion and vasoactive-inotropic score at postoperative 24 hours (VIS 24) were recorded. Results No significant difference was found in age, body weight, ejection fraction, hematokrit, CPB time and cross-clamping time between the DNC group and CTC group. There was no significant difference in the rate of spontaneous defibrillation, VIS 24, cardiac enzymes and cardiactroponin I and length of ICU stay between the two groups. The total volume and transfusion frequency of cardioplegia, perioperative blood transfusion were lower in the DNC group. There was no new atrial fibrillation or in-hospital death in the two groups. Conclusion Del Nido is a good myocardial protection solution in adult cardiac valve surgery, and requires less static preload volume and reduceshemodilution and perioperative blood transfusion.
Objective To observe the protective effects of diazoxide-preconditioning on myocardial ischemiareperfusion injury of rats and discuss its possible mechanisms. Methods Fourteen healthy SD rats were randomly divided into two groups（7 each group）,In diazoxide-preconditioning group diazoxide was injected with the dosage of 12.5mg/kg through the vein,and in control group the media with the same amount was only given before ischemia. The left anterior descending branch was ligated for 2 hours. The heart was quickly excised after 2 hours reperfusion to be used for measurement of the quantity of malondialdehyde（MDA）, the activity of superoxide dismutase （SOD）, the size of myocardial infarct area, and the cell apoptosis and ultrastructure in ischemic area. Results Compared with the control group, the quantity of MDA,the percentage of the weight of myocardial infarct area/ischemic area, and the rate of cell apoptosis in the diazoxide-preconditioning group were greatly reduced （P〈0.05, 0. 01）. The damage of cell uhrastructure was obviously alleviated,Conclusion Diazoxide-preconditioning provides evident cardioprotective effect on the myocardial ischemia-reperfusion injury of rats.
Hemoglobin-based oxygen carriers (HBOCs) is a kind of blood substitutes. It is a separated, ultra-purified, modified human or bovine hemoglobin in a balanced saline solution. After modification, it has longer half-time, less renal toxicity, and better delivery of O2 even at low temperature and pH. Its shelf life is long and it dose not require cross-matching. In the field of cardiac surgery, the use of HBOCs can reduce the amount of transfusion postoperatively, and can be used in cardiopulmonary bypass priming and myocardial protection.
From aortic declamping to weaning from cardiopulmonary bypass (CPB), myocardium needs recovery not only from surgical and ischemia/reperfusion injury, but also of its full performance of pumping function as quickly as possible. In the early period of resuming myocardial perfusion, coronary blood flow should be increased, but ventricular volume overload, large dosage of adrenaline and isoprenaline, and high-energy defibrillation should be avoided. Thenappropriate management according to cardiac function and ECG changes is needed for successful weaning from CPB.
ObjectiveTo compare the myocardial protective effect of HTK solution and St.ThomasⅡ(STH) solution in immature rabbit myocardium at different cardiac arrest time. MethodsAccording to cardioplegia and cardiac arrest time, 32 immature New Zealand white rabbits (aged 2-3 weeks) were randomly divided into four groups. A group SO (8 rabbits) underwent 1 hour cardiac arrest with STH solution, a group ST (8 rabbits) underwent 2 hours cardiac arrest with STH solution, a group HO (8 rabbits) underwent 1 hour cardiac arrest with HTK solution, a group Ht (8 rabbits) underwent 2 hours cardiac arrest with HTK solution. Compare the myocardial protective effect of HTK and STH solution in immature myocardium at different cardiac arrest time. ResultsThe Langendorff models were successfully established in 30 cases (8 cases in the group SO and HO, 7 cases in the group ST and HT). There were no statistical differences in hemodynamics and myocardial enzyme (CK-MB, LDH) (P > 0.05), but HTK solution reduced the activity of nitric oxide synthase (NOS) and content of malonaldehyde (MDA) and NO, maintained high activity of superoxide dismutase (SOD) and Ca2+-ATPase (P < 0.05), performed more effective myocardial protection for immature myocardium. ConclusionHTK solution has more effective myocardial protection for immature myocardium than STH solution does, but STH solution still has good outcomes within short cardiac arrest time (1h).
Objective To investigate the immature myocardial protection effects with renal ischemic preconditioning. Methods 18 neonatal rabbits were randomly divided into three groups. Ischemic/reperfusion(I/R) group underwent 45 min ischemia followed with 45 min reperfusion after Langendorff model performed. Cardiac ischemic preconditioning(CIP) group underwent 45 min ischemia followed with 45 min reperfusion after 5 min ischemia and then 5 min reperfusion for two times. Renal ischemic preconditioning(RIP) group underwent 45 min ischemia followed with 45 min reperfusion after renal artery obstruction for 5 min and 5 min reperfusion for three times.The left ventricular function recovery,myocardial water content(MWC), lactate dehydrogenase (LDH) and creatine kinase(CK) leakage, malondialdehyde(MDA) content,adenosine triphosphate(ATP) content, superoxide dismutase(SOD) activity, myocardial cell Ca2+ ［Ca2+］c content,mitochondrial Ca 2+ content ［Ca2+］m,synthesizing ATP activity of mitochondria ［ATP］m and Ca2+ATPase activity of mitochondria ［Ca2+ATPase］m were tested. Results The recovery of postischemic heart function in RIP group and CIP group were higher than that I/R group(Plt;0.01). There were no significant difference of HR, AF in three groups （Pgt;0.05）. There were significant difference of CF，CO，LVSP and LVEDP in RIP group and CIP group than those I/R group（Plt;0.01）. There were significant difference of MWC, CK, LDH, ATP content, MDA, SOD activity, ［Ca2+］c content, ［Ca2+ATPase］m， ［Ca2+］m and ［ATP］m in RIP group than those I/R group（Plt;0.01). There were no significant difference between RIP group and CIP group upon every index (Pgt;0.05). Conclusion RIP has the same cardioprotection to immature myocardium as ischemic preconditioning.
Objective To observe the protective effects of diazoxide-preconditioning on myocardial ischemiareperfusion injury of rats and discuss its possible mechanisms. Methods Fourteen healthy SD rats were randomly divided into two groups（7 each group）,In diazoxide-preconditioning group diazoxide was injected with the dosage of 12.5mg/kg through the vein,and in control group the media with the same amount was only given before ischemia. The left anterior descending branch was ligated for 2 hours. The heart was quickly excised after 2 hours reperfusion to be used for measurement of the quantity of malondialdehyde（MDA）, the activity of superoxide dismutase （SOD）, the size of myocardial infarct area, and the cell apoptosis and ultrastructure in ischemic area. Results Compared with the control group, the quantity of MDA,the percentage of the weight of myocardial infarct area/ischemic area, and the rate of cell apoptosis in the diazoxide-preconditioning group were greatly reduced （P〈0.05, 0. 01）. The damage of cell uhrastructure was obviously alleviated,Conclusion Diazoxide-preconditioning provides evident cardioprotective effect on the myocardial ischemia-reperfusion injury of rats.
Cardiac injury is a major complication of cardiac surgery. Surgical manipulation, systemic inflammatory response and cardiac ischemia/reperfusion injury (IRI)are main reasons of cardiac injury. Gentle and swift surgical manipulation can reduce mechanical myocardial injury, shorten myocardial ischemic time, and reduce myocardial IRI. Satisfactory myocardial protection plays a key role to improve postoperative recovery. In recent years, more and more myocardial protection strategies are employed to reduce myocardial IRI and improve myocardial protection, including modifications of temperature, composition and instillation approach of cardioplegia in order to increase myocardial oxygen supply, decrease myocardial oxygen consumption, inhibit inflammatory response and eliminate oxygen free radicals. Endogenous myocardial protection is also achieved by supplement of certain medications in cardioplegia.