Investigation of Myocardial Protection Efficacy of Cardioplegia Solutions Used in Open Heart Surgery
NCT ID: NCT06373549
Last Updated: 2024-04-18
Study Results
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Basic Information
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COMPLETED
2 participants
OBSERVATIONAL
2022-12-08
2023-07-24
Brief Summary
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Blood cardioplegia is an autologous cardioplegia that includes physiological buffer systems, allowing for heart nourishment and containing native antioxidant systems. However, the need for repeated doses every 20 minutes after the initial application creates a disadvantage in terms of surgical comfort. On the other hand, del Nido cardioplegia is preferred by surgeons in complex cases due to its long application intervals. The adequacy of a single dose for up to 90 minutes after the initial application creates an advantage in terms of surgical comfort and surgical integrity. However, the content being predominantly electrolyte-based, containing 1:4 ratio of autologous blood, and the extended time of a single dose are disadvantages compared to blood cardioplegia in terms of heart nourishment and protection from ischemia. In addition to these different usage scenarios, the myocardial protective effects of cardioplegias on cellular redox homeostasis are also among the current research topics. Thesis project can contribute to the current literature and clinical practice on the cardioprotective advantages of cardioplegia solutions and the reasons for their preference in surgery.
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Detailed Description
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In this study preferred the blood and del Nido cardioplegia solutions, which are commonly used in clinic. Blood cardioplegia is an autologous cardioplegia that includes physiological buffer systems, allowing for heart nourishment and containing native antioxidant systems. However, the need for repeated doses every 20 minutes after the initial application creates a disadvantage in terms of surgical comfort. On the other hand, del Nido cardioplegia is preferred by surgeons in complex cases due to its long application intervals.
The adequacy of a single dose for up to 90 minutes after the initial application creates an advantage in terms of surgical comfort and surgical integrity. However, the content being predominantly electrolyte-based, containing 1:4 ratio of autologous blood, and the extended time of a single dose are disadvantages compared to blood cardioplegia in terms of heart nourishment and protection from ischemia. Hamad et al reported that del Nido and blood cardioplegia solutions offer equivalent safety in combined adult valve surgery. In addition to these differences, the myocardial protective effects of cardioplegias on myocardial redox homeostasis are also among the current research topics. Ischemia and reperfusion injury can be observed in the myocardial tissues of patients undergoing coronary artery bypass graft surgery and isolated valve replacement surgery. It was reported that coronary sinus blood sampling gives an insight into the localized pathophysiology of heart diseases. Comparative research examining the effects of blood and del Nido cardioplegia solutions on coronary sinus redox status is not currently available in the literature. The study aim to contribute to the development of effective strategies to minimize oxidative damage associated with cardiac surgery by investigating the effects of blood and del Nido cardioplegia solutions on coronary sinus redox homeostasis during the preoperative and postoperative periods using redox biomarkers and antioxidant system transcription factors. Thesis project also intend to compare these redox effects with elective isolated valve replacement surgery patients, who do not have coronary artery disease but share a similar pathogenesis with potential strategies for minimizing oxidative damage associated with cardiac surgery using cardiopulmonary bypass (CPB).
Conditions
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Study Design
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COHORT
PROSPECTIVE
Study Groups
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Patients with coronary artery bypass surgery due to coronary artery disease
From the patients included in the study, blood samples will be taken from the systemic venous circulation before the operation, and from the coronary sinus at 4 minutes before and after the cross-clamp, via a retrograde cardioplegia cannula into yellow capped gel tubes.
Patients with coronary artery bypass surgery routine procedural administration of cardioplegia solutions
To investigate the effectiveness of myocardial protection methods, blood samples were collected from the coronary sinus before the aortic cross-clamping and at 4 minutes after aortic cross-clamping, through a coronary sinus cannula with a yellow-capped gel tube. The collected blood samples were kept in an upright position for 20 minutes to allow separation into serum fraction, then centrifuged at 3000 g for 10 minutes (Beckman Coulter, Microfuge 16, USA). The obtained serums were aliquoted into 250 μl portions in Eppendorf tubes, separately for each patient.
Patients who underwent heart valve surgery without coronary artery disease routine procedural administration of cardioplegia solutions
To investigate the effectiveness of myocardial protection methods, blood samples were collected from the coronary sinus before the aortic cross-clamping and at 4 minutes after aortic cross-clamping, through a coronary sinus cannula with a yellow-capped gel tube. The collected blood samples were kept in an upright position for 20 minutes to allow separation into serum fraction, then centrifuged at 3000 g for 10 minutes (Beckman Coulter, Microfuge 16, USA). The obtained serums were aliquoted into 250 μl portions in Eppendorf tubes, separately for each patient.
Patients who underwent heart valve surgery without coronary artery disease
From the patients included in the study, blood samples will be taken from the systemic venous circulation before the operation, and from the coronary sinus at 4 minutes before and after the cross-clamp, via a retrograde cardioplegia cannula into yellow capped gel tubes.
Patients with coronary artery bypass surgery routine procedural administration of cardioplegia solutions
To investigate the effectiveness of myocardial protection methods, blood samples were collected from the coronary sinus before the aortic cross-clamping and at 4 minutes after aortic cross-clamping, through a coronary sinus cannula with a yellow-capped gel tube. The collected blood samples were kept in an upright position for 20 minutes to allow separation into serum fraction, then centrifuged at 3000 g for 10 minutes (Beckman Coulter, Microfuge 16, USA). The obtained serums were aliquoted into 250 μl portions in Eppendorf tubes, separately for each patient.
Patients who underwent heart valve surgery without coronary artery disease routine procedural administration of cardioplegia solutions
To investigate the effectiveness of myocardial protection methods, blood samples were collected from the coronary sinus before the aortic cross-clamping and at 4 minutes after aortic cross-clamping, through a coronary sinus cannula with a yellow-capped gel tube. The collected blood samples were kept in an upright position for 20 minutes to allow separation into serum fraction, then centrifuged at 3000 g for 10 minutes (Beckman Coulter, Microfuge 16, USA). The obtained serums were aliquoted into 250 μl portions in Eppendorf tubes, separately for each patient.
Interventions
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Patients with coronary artery bypass surgery routine procedural administration of cardioplegia solutions
To investigate the effectiveness of myocardial protection methods, blood samples were collected from the coronary sinus before the aortic cross-clamping and at 4 minutes after aortic cross-clamping, through a coronary sinus cannula with a yellow-capped gel tube. The collected blood samples were kept in an upright position for 20 minutes to allow separation into serum fraction, then centrifuged at 3000 g for 10 minutes (Beckman Coulter, Microfuge 16, USA). The obtained serums were aliquoted into 250 μl portions in Eppendorf tubes, separately for each patient.
Patients who underwent heart valve surgery without coronary artery disease routine procedural administration of cardioplegia solutions
To investigate the effectiveness of myocardial protection methods, blood samples were collected from the coronary sinus before the aortic cross-clamping and at 4 minutes after aortic cross-clamping, through a coronary sinus cannula with a yellow-capped gel tube. The collected blood samples were kept in an upright position for 20 minutes to allow separation into serum fraction, then centrifuged at 3000 g for 10 minutes (Beckman Coulter, Microfuge 16, USA). The obtained serums were aliquoted into 250 μl portions in Eppendorf tubes, separately for each patient.
Eligibility Criteria
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Inclusion Criteria
* Patients without coronary artery disease who underwent elective valve surgery
* Patients between the ages of 18-75
* Having a BMI of 18.5-30
Exclusion Criteria
* Patients older than 75 years
* Patients requiring valve surgery (combined surgical procedure) with coronary artery bypass
* Patients who underwent emergency coronary bypass
* BMI \> 30 obese patients
18 Years
75 Years
ALL
No
Sponsors
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Istanbul University - Cerrahpasa
OTHER
Tamer cebe
OTHER
Responsible Party
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Tamer cebe
Asistant Doctor
Locations
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SBÜ. Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi Erişkin Kalp ve Damar Cerrahisi Kliniği
Istanbul, Kadıköy, Turkey (Türkiye)
Countries
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References
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Carvajal C, Goyal A, Tadi P. Cardioplegia. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK554463/
Comentale G, Giordano R, Palma G. Comparison of the different cardioplegic strategies in cardiac valves surgery: who wins the "arm-wrestling"? J Thorac Dis. 2018 Feb;10(2):714-717. doi: 10.21037/jtd.2018.01.133. No abstract available.
Weber C, Jenke A, Chobanova V, Yazdanyar M, Chekhoeva A, Eghbalzadeh K, Lichtenberg A, Wahlers T, Akhyari P, Paunel-Gorgulu A. Targeting of cell-free DNA by DNase I diminishes endothelial dysfunction and inflammation in a rat model of cardiopulmonary bypass. Sci Rep. 2019 Dec 17;9(1):19249. doi: 10.1038/s41598-019-55863-8.
Atayik MC, Cakatay U. Redox signaling and modulation in ageing. Biogerontology. 2023 Oct;24(5):603-608. doi: 10.1007/s10522-023-10055-w. Epub 2023 Aug 3.
Ulasov AV, Rosenkranz AA, Georgiev GP, Sobolev AS. Nrf2/Keap1/ARE signaling: Towards specific regulation. Life Sci. 2022 Feb 15;291:120111. doi: 10.1016/j.lfs.2021.120111. Epub 2021 Oct 31.
Calabrese EJ, Kozumbo WJ. The hormetic dose-response mechanism: Nrf2 activation. Pharmacol Res. 2021 May;167:105526. doi: 10.1016/j.phrs.2021.105526. Epub 2021 Mar 2.
GIBBON JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med. 1954 Mar;37(3):171-85; passim. No abstract available.
Topcu AC, Bolukcu A, Ozeren K, Kavasoglu T, Kayacioglu I. Normoxic management of cardiopulmonary bypass reduces myocardial oxidative stress in adult patients undergoing coronary artery bypass graft surgery. Perfusion. 2021 Apr;36(3):261-268. doi: 10.1177/0267659120946733. Epub 2020 Aug 5.
Cebe T, Yanar K, Atukeren P, Ozan T, Kuruc AI, Kunbaz A, Sitar ME, Mengi M, Aydin MS, Esrefoglu M, Aydin S, Cakatay U. A comprehensive study of myocardial redox homeostasis in naturally and mimetically aged rats. Age (Dordr). 2014;36(6):9728. doi: 10.1007/s11357-014-9728-y. Epub 2014 Nov 11.
Cebe T, Atukeren P, Yanar K, Kuruc AI, Ozan T, Kunbaz A, Sitar ME, Mirmaroufizibandeh R, Aydin S, Cakatay U. Oxidation scrutiny in persuaded aging and chronological aging at systemic redox homeostasis level. Exp Gerontol. 2014 Sep;57:132-40. doi: 10.1016/j.exger.2014.05.017. Epub 2014 May 28.
Other Identifiers
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2022/183-3896
Identifier Type: -
Identifier Source: org_study_id
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