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CARDIOPLEGIA

CARDIOPLEGIA. K. PREETHRAJH. History. HYPOTHERMIA CROSS-CLAMPING-1956-COOLEY&DEBAKEY –USED 1969 VENTRICULAR-FIBRILLATION 1969-NAJAFI 1972-STONE HEART PHENOMENON-COOLEY 1956-POTASSIUM CITRATE—MELROSE,RINGER..USED BY THE EFFLER’S GROUP . POTASSIUM . USED IN 1973 in lower doses

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CARDIOPLEGIA

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  1. CARDIOPLEGIA K.PREETHRAJH PAST---------PRESENT

  2. History • HYPOTHERMIA • CROSS-CLAMPING-1956-COOLEY&DEBAKEY –USED 1969 • VENTRICULAR-FIBRILLATION 1969-NAJAFI • 1972-STONE HEART PHENOMENON-COOLEY • 1956-POTASSIUM CITRATE—MELROSE,RINGER..USED BY THE EFFLER’S GROUP PAST---------PRESENT

  3. POTASSIUM • USED IN 1973 in lower doses • 20-30mmol/1000ml crystalloid • IN EUROPE ADDITIVES (procaine.magnesium) PAST---------PRESENT

  4. Other types of myocardial preservation • Electrical • Coronary perfusion • Beta blockade • hypothermia PAST---------PRESENT

  5. Types of cardioplegia • Crystalloid: • Oxygenated crystalloid • Blood cardioplegia: cold tepid • Leukocyte depleted PAST---------PRESENT

  6. Delivery methods: Antegrade Retrograde Root pressure PAST---------PRESENT

  7. Buckberg cardioplegia • 4:1 blood plegia • 3 solutions :induction maintaince reperfusion • Cold------- 8-12 degrees Celsius • Hot shot----37degrees Celsius • Reperfusion –32degrees Celsius • Delivery is fixed volume over time and pressure PAST---------PRESENT

  8. Buckberg cardioplegia composition /1000ml PAST---------PRESENT

  9. Additives • Mg sulphate • Dextrose 50%-35ml/500ml of solution • Lignocaine 100mg after cross- clamping • Adenosine • manitol PAST---------PRESENT

  10. Precautions taken during plegia delivery • Flow: occlusion • Temperature • Volumes • Time • Pressure • Others PAST---------PRESENT

  11. Disadvantages • High potassium levels • High dextrose levels • Can complicate CPB • Hot shot can cause excessive vaso-dilation • Protocol may have to be modified for short aortic clamp times • Aortic regurgitation PAST---------PRESENT

  12. Advantages • Improved left ventricular function(echocardiography assessment)?????? • Hearts may not need defibrillation • Accurate Temperature control PAST---------PRESENT

  13. Thank you PAST---------PRESENT

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