cardioplegia solutions comparison.

1. Cardioplegia
Jinil Raj

2. Outline
• Classification.
• Composition of different Cardioplegias.
• Our protocol.
• Comparison of cold VS warm Cardioplegia.
• Comparison of blood VS Crystalloid Cardioplegia.
• Comparison of Delnido VS Other Blood Cardioplegia.
• Microplegia.
• Warm induction Cardioplegia and Hot Shot.
• Myocardial dysfunction after Cardiac Surgery.
• Conclusion & discussion.

3. Classification of Cardioplegia

4. Composition of different
Cardioplegias

5. Cardioplegia Composition &
Protocols in PSCC
Adopted from American society of extra corporeal technology
Additives Volume Concentration
Potassium Chloride 30 ml 60 meq
Sodium Bicarbonate 10 ml 10 meq
Magnesium Sulphate 10 ml 1 gm
Lidocaine 2.5 ml 50 mg
Mannitol 10 ml 0.2 gm
4:1,Cold Blood Cardioplegia, Volume of Administration 10 to
30 ml/kg with antegrade pressure not more than150 mmHg
and retrograde pressure less than 35 mmHg. Cardioplegia
temperature 7 to 10 degree.

6. Comparison of Cold VS Warm
Cardioplegia

7. Results
• Warm Cardioplegia group had better Cardiac index
and less cardiac markers.
• No significant differences in postoperative rates of
mortality, MI, LCOS, IABP use, stroke, new AF &
AKI, between the use of warm and cold
Cardioplegia.
• The choice of warm versus cold Cardioplegia
solution remains the surgeon’s preference.

8. Comparison of Crystalloid VS Blood
Cardioplegia

9. Results
• Significantly lower incidence of low
output syndrome (LOS) and CK-MB
release with blood Cardioplegia.
• No differences in myocardial
infarction or mortality.

10. Delnido VS blood Cardioplegia

11. Results

12. Microplegia

13. Results
• Microplegia is similar to other
Cardioplegia choices and may
offer some advantages in terms
of early return to spontaneous
heartbeat, less requirement for
inotropic support, shorter ICU
stay, and lower CK‐MB release.

14. Warm Induction Cardioplegia
•Less use of Temporary Pacemakers.
•Better Myocardial recovery during reperfusion time.
•Better cardiac Troponin levels.
•Shorter Mechanical Ventilation and ICU stay.

15. Hot shot
A shot of hyperkalemic Warm-blood Cardioplegia before
declamping achieves prompt metabolic and contractile
recovery of arrested hearts.

16. Myocardial
dysfunction
after Surgery
Improper composition
and delivery
Ventricular distension
Myocardial rewarming
Ischemia
reperfusion injury
Preoperative LV
dysfunction
Confirm the content
with ABG
Maintain proper root
pressure
Venting
Topical Cooling
Proper assessment,
Preop optimization
Pharmacological
modulation,
preconditioning

17. Conclusion
• Blood Cardioplegia.
• Delnido Cardioplegia?.
• Warm induction followed by cold
blood Cardioplegia.
• Microplegia can be considered.
• Hypokalemic Hotshot.

18. Thank You..