Document Detail


Changes in myocardial free amino acids during pediatric cardiac surgery: a randomised controlled trial of three cardioplegic techniques.
MedLine Citation:
PMID:  16723246     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The developing heart has a much greater dependence on amino acid (AA) metabolism than the adult heart in determining its ischemic tolerance. Blood cardioplegia preserves myocardial free AAs in adult hearts but no clinical studies have looked at the effect of different cardioplegic techniques on intracellular free AAs in the pediatric heart. METHODS: Pediatric patients were randomised to receive intermittent antegrade cold crystalloid (CC), cold blood (CB) or cold blood cardioplegia with a 'hot shot' (CB+HS). Right ventricular biopsies were collected prior to ischemia, at the end of ischemia and 20 min after reperfusion. Amino acid levels were analysed as repeated measures, adjusting for baseline levels. Data were analysed separately for acyanotic and cyanotic patients. RESULTS: Of 103 patients recruited, 32 (22 acyanotic and 10 cyanotic), 36 (24/12) and 35 (25/10), respectively were allocated to CC, CB and CB+HS groups. Cyanotic patients were significantly younger with longer cross-clamp times. In acyanotic patients, there were no significant effects of cardioplegic method on aspartate, glutamine, taurine, alanine or branched chain AA levels (all p>0.05). However, in cyanotic patients, there were significant interactions of cardioplegic method and time (all p<0.05) for all amino acids, with patients allocated to CB+HS having higher levels after reperfusion compared with CC, and patients allocated to CB having intermediate levels. CONCLUSIONS: For cyanotic patients (younger, longer cross-clamp times), CB+HS preserves myocardial free AAs better than CC; CB gives an intermediate effect. In acyanotic patients, AA levels (all p>0.15) and group means were similar both at the end of ischemia and after reperfusion.
Authors:
Paul Modi; Saadeh M Suleiman; Barnaby C Reeves; Ash Pawade; Andrew J Parry; Gianni D Angelini; Massimo Caputo
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2006-05-24
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  30     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-06-13     Completed Date:  2006-08-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  41-8     Citation Subset:  IM    
Affiliation:
Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Amino Acids / metabolism*
Child
Child, Preschool
Cyanosis / metabolism
Female
Heart Arrest, Induced / methods*
Heart Defects, Congenital / metabolism,  surgery*
Humans
Infant
Male
Myocardial Reperfusion
Myocardium / metabolism*
Potassium Compounds
Chemical
Reg. No./Substance:
0/Amino Acids; 0/Potassium Compounds; 0/potassium cardioplegic solution

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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