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Journal articles on the topic 'Cardioplegic Solutions'

Author: Grafiati

Published: 4 June 2021

Last updated: 1 February 2022

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1

Přistoupil, T. I., M. Vrána, J. Havlíčková, and M. Kramlová. "Hemoglobin Solutions in Experimental Cardioplegia." International Journal of Artificial Organs 12, no. 10 (October 1989): 668–72. http://dx.doi.org/10.1177/039139888901201013.

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The addition of stroma-free hemoglobin solution to a standard St. Thomas Hospital cardioplegic solution significantly protected the heart from ischemic damage compared to the effect of the same solution without added hemoglobin. An experimental model of rat heart cardioplegia and transplantation comprising heart arrest for three hours at 20°C was used. The number of hearts performing strong contractions after cardioplegia with iso-oncotic oxyhemoglobin prior to transplantation was close to the results with histidine-buffered cardioplegic solution according to Bretschneider. Comparative biochemical model experiments in vitro confirmed that the positive effect of oxyhemoglobin was due predominantly to its buffering capacity. The role of oxygen transport to tissues by hemoglobin was limited only to the first minutes of cardioplegia since neither recirculation nor reoxygenation took place in the present experimental setting.

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2

Семенов, P. Semenov, Малютин, V. Malyutin, Ковалев, S. Kovalev, Колмыков, et al. "Assessment of the Efficiency of Different Cardioplegic Solutions Based on the Study of Laboratory Parameters in Surgical Patients with Infectious Endocarditis of Left Parts of the Heart." Journal of New Medical Technologies 21, no. 2 (August 13, 2014): 32–37. http://dx.doi.org/10.12737/4993.

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The study included 238 cases of surgical treatment of patients with infectious endocarditis of left parts of heart. The operations of single or multivalve reconstruction or restoration in conditions of artificial circulation were made to these patients. The patients were divided into groups depending on the type of cardioplegic solution. The influence of methods of cold crystalloid (extracellu-lar and intracellular), and blood cardioplegia on clinical and laboratory indices, which characterize the severity of myocardial damage in intra - and postoperative periods, was studied. The obtained results showed that the use of all types of cardioplegic solutions allows to provide the myocardial protection during the operation and to decrease the risk of life-threatening complications in this category of patients. The increase in the level of laboratory parameters of myocardial damage was registered in the use of all types of cardioplegic solutions in patients with long anoxia. The lowest intensity of changes in the levels of blood lactate marked using a solution for cold crystalloid intracellular cardioplegia. The greatest changes of this indicator were identified in patients receiving blood potassium cardioplegia. The use of cardioplegic solution "Custodial" caused the greatest intensity of acidosis in the intra-operative period.

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3

O. Tyers, G. Frank. "Cardioplegic solutions." Journal of Thoracic and Cardiovascular Surgery 98, no. 2 (August 1989): 291. http://dx.doi.org/10.1016/s0022-5223(19)34425-3.

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4

Lim, Kelvin H. H., Andrew P. Halestrap, Gianni D. Angelini, and M. Saadeh Suleiman. "Propofol Is Cardioprotective in a Clinically Relevant Model of Normothermic Blood Cardioplegic Arrest and Cardiopulmonary Bypass." Experimental Biology and Medicine 230, no. 6 (June 2005): 413–20. http://dx.doi.org/10.1177/15353702-0323006-09.

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The general anesthetic propofol has been shown to be cardioprotective. However, its benefits when used in cardioplegia during cardiac surgery have not been demonstrated. In this study, we investigated the effects of propofol on metabolic stress, cardiac function, and injury in a clinically relevant model of normothermic cardioplegic arrest and cardiopulmonary bypass. Twenty anesthetized pigs, randomized to propofol treatment ( n = 8) and control ( n =12) groups, were surgically prepared for cardiopulmonary bypass (CPB) and cardioplegic arrest. Doses of warm blood cardioplegia were delivered at 15-min intervals during a 60-min aortic cross-clamped period. Propofol was continuously infused for the duration of CPB and was therefore present in blood cardioplegia. Myocardial biopsies were collected before, at the end of cardioplegic arrest, and 20 mins after the release of the aortic cross-clamp. Hemodynamic parameters were monitored and blood samples collected for cardiac troponin I measurements. Propofol infusion during CPB and before ischemia did not alter cardiac function or myocardial metabolism. Propofol treatment attenuated the changes in myocardial tissue levels of adenine nucleotides, lactate, and amino acids during ischemia and reduced cardiac troponin I release on reperfusion. Propofol treatment reduced measurable hemodynamic dysfunction after cardioplegic arrest when compared to untreated controls. In conclusion, propofol protects the heart from ischemia-reperfusion injury in a clinically relevant experimental model. Propofol may therefore be a useful adjunct to cardioplegic solutions as well as being an appropriate anesthetic for cardiac surgery.

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5

Cvetkovic, Dragan, Mladen Kocica, Ljiljana Soskic, Filip Vucicevic, Olga Petrovic, Ivana Jovanovic, Snezana Jovicic, et al. "Comparison of Custodiol® and modified St. Thomas cardioplegia for myocardial protection in coronary artery bypass grafting." Vojnosanitetski pregled 77, no. 11 (2020): 1126–34. http://dx.doi.org/10.2298/vsp181108192c.

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Background/Aim. Custodiol? is a hyperpolarizing cardioplegic solution which has been used in our national cardiac surgical practice exclusively for the heart transplant surgery. Owing to its numerous advantages over the standard depolarizing solutions, Custodiol? became cardioplegic solution of choice for all other cardiac surgical procedures in many cardio-surgical centers. This study evaluated myocardial protection by Custodiol? compared to modified St. Thomas cardioplegic solution in coronary artery bypass surgery. Methods. In a prospective four-month study, 110 consecutive adult patients who underwent primary isolated elective on-pump coronary artery bypass grafting (CABG) were randomized into the Custodiol? group (n = 54) and the St. Thomas groupa (n = 50), based on the type of administered cardioplegia; six patients were excluded. Cardiac protection was achieved as antegrade cold crystalloid cardioplegia by one of the solutions. Myocardial preservation was assessed through following outcomes: spontaneous rhythm restoration post cross-clamp, and postpoperative cardiac specific enzymes level, ejection fraction (EF) change, inotropic support, myocardial infarction (MI), atrial fibrillation (AF), and death. Results. Preoperative and intraoperative characteristics of patients in both groups were similar except for a considerably longer cross-clamp time in the Custodiol? group (49.1 ? 19.0 vs. 41.0 ? 12.9 minutes; p = 0.022). The Custodiol? group exhibited a higher rate of return to spontaneous rhythm compared to the St. Thomas group (31.5% vs. 20.0%, respectively; p = 0.267), lower rates of AF (20.4% vs. 28%, respectively; p = 0.496), MI (1.8% vs. 10.0%, respectively; p = 0.075) and inotropic support (9.0% vs. 12.0%, respectively; p = 0.651), albeit not statistically significant. There was an insignificant difference in peak value of troponin I between the Custodiol? and Thee St. Thomas group (5.0 ? 3.92 ?g/L vs. 4.5 ? 3.39 ?g/L, respectively; p = 0.755) and creatine kinase-MB (26.9 ? 15.4 ?g/L vs. 28.5 ? 24.2 ?g/L, respectively; p = 0.646) 6 hours post-surgery. EF reduction was comparable (0.81% vs. 1.26%; p = 0.891). There were no deaths in both groups. Conclusions. Custodiol? and modified St.Thomas cardioplegic solution have comparable cardioprotective effects in CABG surgery. The trends of less frequent MI, AF and ino-tropic support, despite the longer cross-clamp time in the Custodiol? group may suggest that its benefits could be ascertained in a larger study.

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6

Hendren, William G., Gillian A. Geffin, Tim R. Love, James S. Titus, Brian E. Redonnett, Dennis D. O’Keefe, and Willard M. Daggett. "Oxygenation of cardioplegic solutions." Journal of Thoracic and Cardiovascular Surgery 94, no. 4 (October 1987): 614–25. http://dx.doi.org/10.1016/s0022-5223(19)36227-0.

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7

Glöckner, Anna, Susann Ossmann, Andre Ginther, Jagdip Kang, Michael A. Borger, Alexandro Hoyer, and Maja-Theresa Dieterlen. "Relevance and Recommendations for the Application of Cardioplegic Solutions in Cardiopulmonary Bypass Surgery in Pigs." Biomedicines 9, no. 9 (September 21, 2021): 1279. http://dx.doi.org/10.3390/biomedicines9091279.

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Cardioplegic solutions play a major role in cardiac surgery due to the fact that they create a silent operating field and protect the myocardium against ischemia and reperfusion injury. For studies on cardioplegic solutions, it is important to compare their effects and to have a valid platform for preclinical testing of new cardioplegic solutions and their additives. Due to the strong anatomical and physiological cardiovascular similarities between pigs and humans, porcine models are suitable for investigating the effects of cardioplegic solutions. This review provides an overview of the results of the application of cardioplegic solutions in adult or pediatric pig models over the past 25 years. The advantages, disadvantages, limitations, and refinement strategies of these models are discussed.

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8

Risk, Y. E., B. M. Abdelgawad, A. M. Elnahas, and M. M. Melad. "Comparative Study between Cardioplegic Solution (Custodiol) versus Conventional Cardioplegic Solutions in CABG Patients." Benha Journal of Applied Sciences 6, no. 1 (February 1, 2021): 263–66. http://dx.doi.org/10.21608/bjas.2021.169123.

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9

Brackenbury, ET, R. Sherwood, N. Meehan, MA Whitehorne, AT Forsyth, MT Marrinan, and JB Desai. "Troponin T release with warm and cold cardioplegia." Perfusion 11, no. 5 (September 1996): 377–82. http://dx.doi.org/10.1177/026765919601100504.

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Cardiac troponin T (cTnT) levels were measured in 41 patients undergoing elective coronary artery surgery. Twenty-one patients received continuous warm antegrade blood cardioplegia to maintain asystole whilst 20 patients received antegrade cold blood cardioplegia intermittently. Serum levels of cTnT were determined preoperatively and at 0, 6, 12 and 18 h postbypass. Peak cTnT levels and total cTnT release (calculated from the area under the curve postoperatively) were found to be significantly higher (p < 0.05: Mann-Whitney) when cold cardioplegic solutions were used. Continuous warm cardioplegia results in lower cTnT release than intermittent cold blood cardioplegia suggesting that the former may provide better myocardial preservation.

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10

Eucher, Philippe M., Michel Buche, Serge Broka, and Jean-Claude Schoevaerdts. "Retrieval of crystalloid cardioplegic solutions." Annals of Thoracic Surgery 61, no. 2 (February 1996): 746–47. http://dx.doi.org/10.1016/0003-4975(95)00968-x.

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11

Buckberg, Gerald D. "Hazards of administering blood cardioplegic solution directly into the heart: Cardioplegic solutions are not equal." Journal of Thoracic and Cardiovascular Surgery 111, no. 1 (January 1996): 283–84. http://dx.doi.org/10.1016/s0022-5223(96)70432-4.

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12

Suleiman, M. S., W. C. Dihmis, M. Caputo, G. D. Angelini, and A. J. Bryan. "Changes in myocardial concentration of glutamate and aspartate during coronary artery surgery." American Journal of Physiology-Heart and Circulatory Physiology 272, no. 3 (March 1, 1997): H1063—H1069. http://dx.doi.org/10.1152/ajpheart.1997.272.3.h1063.

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Myocardial ischemic arrest, using a cold crystalloid cardioplegic solution, decreases intracellular concentrations of glutamate (from 6.2 +/- 0.5 to 4.5 +/- 0.45 micromol/g wet weight, n = 19, P < 0.05) and ATP (from 3.0 +/- 0.4 to 1.9 +/- 0.3 micromol/g wet weight, n = 9, P < 0.05) but not aspartate. After 20 min of normothermic reperfusion, the fall in glutamate and ATP was maintained (4.5 +/- 0.52 and 2.0 +/- 0.2 micromol/g wet weight, respectively), and there was a fall in aspartate (from 1.32 +/- 0.12 to 0.9 +/- 0.1 micromol/g wet weight). Myocardial arrest with cold blood cardioplegic solution did not cause a significant fall in tissue ATP, glutamate, or aspartate. However, after reperfusion all three fell significantly. With the exception of a fall in tissue valine during ischemia with cold crystalloid cardioplegic solution and a rise in alanine during ischemia with cold blood cardioplegic solution, there were no significant changes in tissue alanine, valine, leucine, or isoleucine during ischemia or after reperfusion using crystalloid or blood cardioplegic solutions. This work documents the changes in the intracellular concentrations of important metabolites in the hearts of patients undergoing coronary artery surgery using different myocardial protection techniques.

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13

Eugene, John, Kenneth P. Lyons, Richard A. Ott, Vincent L. Gelezunas, Cherylee W. J. Chang, Mark G. Kowall, and Nick J. Haiduc. "Regional Myocardial Perfusion of Cardioplegic Solutions." Annals of Thoracic Surgery 43, no. 5 (May 1987): 522–26. http://dx.doi.org/10.1016/s0003-4975(10)60200-7.

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14

Coetzee, André. "Reply to the Editor: Cardioplegic solutions." Journal of Thoracic and Cardiovascular Surgery 98, no. 2 (August 1989): 291–92. http://dx.doi.org/10.1016/s0022-5223(19)34426-5.

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15

Elassal, Ahmed Abdelrahman, Kkalid Al-Ebrahim, Osman Al-Radi, Zaher Faisal Zaher, Ahmed Mohamed Dohain, Gaser Abdelmohsen Abdelmohsen, Ahmed Hasan Abdulla, et al. "Myocardial Protection by Blood-Based Del Nido versus St. Thomas Cardioplegia in Cardiac Surgery for Adults and Children." Heart Surgery Forum 23, no. 5 (September 24, 2020): E689—E695. http://dx.doi.org/10.1532/hsf.3099.

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Background: St. Thomas (ST) and Del Nido (DN) cardioplegic solutions are widely used for myocardial protection during cardiac surgery. In 2016, our university hospital shifted from modified St. Thomas to Del Nido solution for both adult and pediatric cardiac surgery. This retrospective study was conducted to compare ST and DN solutions regarding surgical workflow and clinical outcome in pediatric and adult patients undergoing cardiac surgery. Methods: We reviewed 220 patients who underwent cardiac surgery requiring cardioplegic arrest. Patients were categorized in 2 groups: ST (n = 110) and DN (n = 110). Each group included 60 pediatric and 50 adult patients. Demographic, intraoperative, and postoperative variables were collected. Results: In pediatric patients, no significant difference was found between the 2 groups regarding clamping time, bypass time, need for defibrillation, inotropic score, postoperative ejection fraction (EF), period of mechanical ventilation, intensive care unit stay, or postoperative arrhythmias. One patient in the ST group required mechanical support by extracorporeal membrane oxygenation. We had 5 cases of pediatric mortality (3 in DN and 2 in ST, P = .64). In adult patients, significantly fewer patients in the DN group needed defibrillation than in the ST group. No significant difference was found regarding clamping time, inotropic score, or intraaortic balloon pump use. Mortality in adult patients was 6 cases (4 in ST group and 2 in DN group). Conclusion: DN cardioplegia solution is as safe as ST solution in pediatric and adult cardiac surgery. It has comparable results of myocardial protection and clinical outcome, with superiority regarding uninterrupted surgery and lower rate of defibrillation.

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16

Tanguary, Hario, Gaëtan Jasmin, Gilbert Blaise, and Louis Dumont. "Resistance of the failing dystrophic hamster heart to the cardioprotective effects of diltiazem and clentiazem: evidence of coronary vascular dysfunctions." Canadian Journal of Physiology and Pharmacology 73, no. 8 (August 1, 1995): 1108–17. http://dx.doi.org/10.1139/y95-158.

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Although hypothermia and cardioplegic cardiac arrest provide effective protection during cardiac surgery, ischemia of long duration, poor preoperative myocardial function, and ventricular hypertrophy may lead to heterogeneous delivery of cardioplegic solutions, incomplete protection, and impaired postischemic recovery. Calcium antagonists are potent cardioprotective agents, but their efficacy in the presence of cold cardioplegia is still controversial, especially in heart failure, since it is often believed that failing hearts are more sensitive to their negative inotropic and chronotropic actions. However, recent data have demonstrated that the benzothiazepine-like calcium antagonists diltiazem and clentiazem, in selected dose ranges, elicit significant cardioprotection independently of intrinsic cardiodepression, thus lending support to their use in cardioprotective maneuvers involving the failing heart. We therefore evaluated the cardioprotective interaction of diltiazem, clentiazem, and cold cardioplegia in both normal and failing ischemic hearts. Hearts were excised from 200- to 225-day-old cardiomyopathic hamsters (CMHs) of the UM-X7.1 line and age-matched normal healthy controls. Ex vivo perfusion was performed at a constant pressure (140 cmH2O; 1 cmH2O = 98.1 Pa) according to the method of Langendorff. Heart rate, left ventricular developed pressure (LVDP), and coronary flow were monitored throughout the study. Global ischemia was produced for 90 min by shutting down the perfusate flow, followed by reperfusion for 30 min. Normal and failing CMH hearts were either untreated (control) or perfused at the onset of global ischemia with one of the following combinations: cold cardioplegia alone (St. Thomas' Hospital cardioplegic solution, 4 °C, infused for 2 min), cold cardioplegia + 10 nM diltiazem, or cold cardioplegia + 10 nM clentiazem. The cardiac and coronary dilator properties of 10 nM diltiazem and 10 nM clentiazem alone were investigated in separate groups of isolated preparations. Failing CMH hearts had lower basal LVDP (42 ± 2 vs. 77 ± 2 mmHg (1 mmHg = 133.3 Pa) for normal hearts, p < 0.05), while coronary flow was only slightly reduced (5.6 ± 0.2 vs. 6.2 ± 0.2 mL/min for normal hearts). Following 90 min global ischemia, coronary flow was increased in both groups, but the peak hyperemic response declined only in failing CMH hearts (+50 ± 17 vs. +82 ± 17% in normal hearts). In normal hearts, LVDP virtually recovered within 5 min of reperfusion but steadily decreased thereafter (−37 ± 4% at 30 min). In contrast, in failing CMH hearts, LVDP significantly decreased early during reperfusion but improved over time (−19 ± 7% at 30 min). In normal hearts, the addition of diltiazem or clentiazem to cold cardioplegic solutions resulted in improved postischemic contractile function for the duration of reperfusion (85 ± 4% vs. only 71 ± 6% for cardioplegia, p < 0.05). The post-ischemic increase in coronary flow was similar in all groups. In failing CMH hearts, the addition of diltiazem or clentiazem afforded no significant contractile benefit at reperfusion. In nonischemic normal hearts, infusion of diltiazem or clentiazem (10 nM) alone increased coronary flow (+6 ± 1% for diltiazem and +24 ± 3% for clentiazem) without significant negative inotropic or chronotropic effects. In nonischemic failing CMH hearts, infusion of diltiazem or clentiazem did not elicit cardiodepression. In contrast their coronary dilator actions reverted to vasoconstriction (diltiazem) or were significantly attenuated (clentiazem). From these experiments we can conclude that, compared with the normal heart, the failing CMH heart adapted differently to global ischemia. In addition to potential alterations in membrane integrity and changes in calcium handling, attenuation of the coronary dilator response to diltiazem and clentiazem rather than an increased sensitivity to their intrinsic cardiodepressant actions appears as a potential contributor to the lack of cardioprotection by these calcium antagonists in the failing CMH hearts.Key words: heart failure, cardioplegia, diltiazem, clentiazem, calcium antagonists, coronary flow, contractility.

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17

Almeida, Adriana Silveira, Rafael Oliveira Ceron, Fernando Anschau, Luciane Kopittke, Kathize Betti Lira, Renan Senandes Delvaux, Juarez Rode, Rafael Antônio Widholzer Rey, Estefânia Inês Wittke, and Alfeu Roberto Rombaldi. "Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial." BMJ Open 11, no. 9 (September 2021): e047942. http://dx.doi.org/10.1136/bmjopen-2020-047942.

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IntroductionMyocardial protection is essential for successful cardiac surgery, and the search for an ideal cardioplegic solution has continued since its beginning. In this context, Custodiol, del Nido and modified del Nido are single-dose cardioplegic solutions with good safety profiles and great relevance in modern surgical practice. While these solutions have all been evaluated for their impact on patient outcomes independently, limited research exists comparing them directly. Thus, the present study aims to examine the effects of these cardioplegic solutions on myocardial protection and clinical outcomes in adult patients undergoing elective cardiac surgery. The assessment of the increase in myocardial injury biomarkers in patients submitted to all treatment methods may be considered a major strength of our study.Methods and analysisThis is a clinical trial study protocol that will compare myocardial protection and clinical outcomes among three patient groups based on which cardioplegic solution was used. Patients will be randomised to receive del Nido (n=30), modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers will be measured at the baseline and 2 hours, 12 hours and 24 hours after the cardiopulmonary bypass. Clinical outcomes will be assessed during the trans operative period and the intensive care unit stay, in addition to other haematological parameters.Ethics and disseminationThis protocol and its related documents were approved by the Research Ethics Committee of the Hospital Nossa Senhora da Conceição, Brazil, registered under no. 4.029.545. The findings of this study will be published in a peer-reviewed journal in the related field.Trial registration numberRBR-7g5s66.

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18

Köksal, Cengiz, Öner Süzer, A. Kürsat Bozkurt, and Sebahat Köseoğlu. "Comparison of Enoximone, Amrinone, or Levosimendan Enriched St. Thomas’ Hospital Cardioplegic Solutions Used for Myocardial Preservation in Isolated Guinea Pig Hearts." Acta Medica (Hradec Kralove, Czech Republic) 45, no. 3 (2002): 93–97. http://dx.doi.org/10.14712/18059694.2019.62.

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Myocardial contractile function after cardioplegic arrest is often depressed and an ideal cardioplegic solution has not been developed yet. The aim of this study was to assess the efficacy of phosphodiesterase III inhibitors, amrinone and enoximone, and levosimendan, a novel Ca2+ sensitizing agent, on recovery of hearts after normothermic cardioplegic arrest when added to the St. Thomas’ hospital cardioplegic solution. In the control group, isolated guinea pig hearts were perfused in Langendorff apparatus and arrested with standard St. Thomas’ solution. In other groups, amrinone (10-5 mol.L-1), levosimendan (10-5 mol.L-1), or enoximone (10-4 mol.L-1) were added to the cardioplegic solution. In all hearts, intraventricular pressure, +dp/dtmax, -dp/dtmax, area under pressure-time curve, heart rate, coronary flow, lactate dehydrogenase and creatine kinase enzyme leakage, and oxygen consumption were measured. In the enoximone group, contractility force and +dp/dtmax, were found to be significantly high in the reperfusion and inotropic periods in comparison with other groups (p<0.05). -dp/dtmax and area under contractility-time curve values were significantly high in inotropic period in enoximone group (p<0.05). No statistically significant difference was noted in other groups. Cardioplegic solution enrichment with enoximone augmented mechanic functions in reperfusion period. No positive effect of amrinone or levosimendan was observed in this study.

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19

Panos, Anthony L., and Salim Aziz. "Recent Developments in Myocardial Protection: Retrograde Cardioplegia." Asian Cardiovascular and Thoracic Annals 5, no. 1 (March 1997): 2–7. http://dx.doi.org/10.1177/021849239700500102.

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In recent years there has been increasing use of coronary sinus perfusion to deliver cardioplegic solutions during open-heart surgery. This has been aided by advances in coronary sinus catheter design and by easier methods of cannula insertion. Coronary sinus perfusion has been used with both intermittent crystalloid and blood cardioplegia and has recently evolved to include retrograde continuous normothermic blood cardioplegia. Coronary sinus perfusion has several advantages including safety, ease of use (with a single cannula placed out of the operative field), usefulness in patients with significant aortic regurgitation, redo coronary artery bypass graft surgery, and acute myocardial infarction. However, there are continuing concerns about the distribution of retrograde perfusion, preservation of right ventricular function, dislodgment of the coronary sinus catheter (and resulting ischemia during surgery), and damage to the coronary sinus.

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20

Fishman, Noel H. "Improved distribution of retrograde cold cardioplegic solutions." Journal of Thoracic and Cardiovascular Surgery 111, no. 3 (March 1996): 683. http://dx.doi.org/10.1016/s0022-5223(96)70329-x.

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21

Yasha Kresh, J., Chet Nastala, P. Carmine Bianchi, Scott M. Goldman, and Stanley K. Brockman. "The relative buffering power of cardioplegic solutions." Journal of Thoracic and Cardiovascular Surgery 93, no. 2 (February 1987): 309–11. http://dx.doi.org/10.1016/s0022-5223(19)36458-x.

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22

SELLEVOLD, O., and P. JYNGE. "Glucocorticoid supplementation to highly filtered cardioplegic solutions." Journal of Molecular and Cellular Cardiology 17 (1985): 23. http://dx.doi.org/10.1016/s0022-2828(85)80212-1.

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23

Nomoto, S. "227 Clinical review of cardioplegic solutions-St. Thomas solution and GK solution." Japanese Journal of Cardiovascular Surgery 15, no. 5 (1986): 458–59. http://dx.doi.org/10.4326/jjcvs.15.458.

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24

Orita, Hiroyuki, Manabu Fukasawa, Hideaki Uchino, Tetsuro Uchida, Satoshi Shiono, and Masahiko Washio. "Cytotoxic effects of cardioplegic solutions and cytoprotective effects of insulin on immature cardiac myocytes during hypothermic preservation." Cardiology in the Young 5, no. 3 (July 1995): 243–50. http://dx.doi.org/10.1017/s1047951100003012.

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AbstractThe purpose of this study was to evaluate the functional and biochemical effects of cardioplegic solutions on immature cardiac myocytes incubated under hypothermic conditions. In addition, the effects of insulin as an additive were evaluated in each solution. Cardiac myocytes were isolated from neonatal rat ventricles and cultured for four days; 12.5 x 105myocytes/flask were then incubated at 4 °C for three, six and 12 hours in three types of cardioplegic solutions—glucose-potassium solution (glucose: 50 gm/l, NaHCO3: 20 mEq, KCl: 20 mEq), lactated Ringer's solution (KCl: 20 mEq) and St. Thomas' Hospital solution. After each hypothermic incubation, enzymes were measured in the incubation solutions. The myocytes were then cultured for an additional 24 hours at 37 °C to evaluate the recovery of the myocyte beating rate. In the Ringer's group, the recovery ratio of the myocyte beating rate was complete at three hours, then decreased to 48.8 percent of control (beating rate prior to hypothermic incubation) at 12 hours. The glucose-potassium and St. Thomas' groups had significantly lower recovery ratios than the Ringer's group, beginning at three hours (63.4, 72.9, 95.6 percent, respectively). Release of enzymes (CPK and LDH) in the Ringer's group gradually increased and at 12 hours was 29.0 mIU/flask and 260.0 mIU/flask, respectively. The St. Thomas' group, in contrast, had significantly increased values for CPK at 12 hours to 116.0 mIU/flask, and the greatest increases of both enzymes were observed in the glucose-potassium group at 12 hours (CPK: 115.5, LDH: 1163.9). By addition of 20 IU/l insulin, marked improvements were observed in the Ringer's and glucose-potassium groups both functionally and biochemically. Thus, the lactated Ringer's solution had the least cytotoxic effects that might be suitable for a basic solution of various cardioplegic solutions during the neonatal period, and insulin may have beneficial effects on immature myocardium under hypothermic conditions.

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25

Buckberg, Gerald D. "Cardioplegic solutions: Unproved herbal approach versus tested scientificstudy." Journal of Thoracic and Cardiovascular Surgery 118, no. 5 (November 1999): 975–77. http://dx.doi.org/10.1016/s0022-5223(99)70080-2.

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26

Lochner, Amanda, Llewelyn Lloyd, Wim Brits, and André Coetzee. "Oxygenation of cardioplegic solutions: A note of caution." Annals of Thoracic Surgery 51, no. 5 (May 1991): 777–87. http://dx.doi.org/10.1016/0003-4975(91)90125-a.

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27

Matsuda, Naruto, Kathleen G. Morgan, and Frank W. Sellke. "Effects of pinacidil on coronary Ca2+-myosin phosphorylation in cold potassium cardioplegia model." American Journal of Physiology-Heart and Circulatory Physiology 279, no. 3 (September 1, 2000): H882—H888. http://dx.doi.org/10.1152/ajpheart.2000.279.3.h882.

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The effects of the potassium (K+) channel opener pinacidil (Pin) on the coronary smooth muscle Ca2+-myosin light chain (MLC) phosphorylation pathway under hypothermic K+cardioplegia were determined by use of an in vitro microvessel model. Rat coronary arterioles (100–260 μm in diameter) were subjected to 60 min of simulated hypothermic (20°C) K+cardioplegic solutions (K+= 25 mM). We first characterized the time course of changes in intracellular Ca2+concentration, MLC phosphorylation, and diameter and observed that the K+cardioplegia-related vasoconstriction was associated with an activation of the Ca2+-MLC phosphorylation pathway. Supplementation with Pin effectively suppressed the Ca2+accumulation and MLC phosphorylation in a dose-dependent manner and subsequently maintained a small decrease in vasomotor tone. The ATP-sensitive K+(KATP)-channel blocker glibenclamide, but not the nitric oxide (NO) synthase inhibitor Nω-nitro-l-arginine methyl ester, significantly inhibited the effect of Pin. K+cardioplegia augments the coronary Ca2+-MLC pathway and results in vasoconstriction. Pin effectively prevents the activation of this pathway and maintains adequate vasorelaxation during K+cardioplegia through a KATP-channel mechanism not coupled with the endothelium-derived NO signaling cascade.

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Katircioğlu, S. Fehmi, Zülfikar Saritaş, A. Tulga Ulus, Birol Yamak, Doğan Yücel, and Selime Ayaz. "Iloprost Added to the Cardioplegic Solutions Improves Myocardial Performance." Prostaglandins & Other Lipid Mediators 55, no. 1 (January 1998): 51–65. http://dx.doi.org/10.1016/s0090-6980(98)00006-9.

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DeBoer, Laurence W. V., Ronald R. Rabjohns, Mary P. Nutt, and David K. Swanson. "Effects of oxygenated cardioplegic solutions on myocardial aerobic metabolism." Journal of Thoracic and Cardiovascular Surgery 104, no. 3 (September 1992): 632–36. http://dx.doi.org/10.1016/s0022-5223(19)34728-2.

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Klamerus, Karen J., and Mark A. Munger. "Composition of cardioplegic solutions used in nine medical centers." American Journal of Health-System Pharmacy 43, no. 6 (June 1, 1986): 1479–82. http://dx.doi.org/10.1093/ajhp/43.6.1479.

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Ali, Ihab, Ahmed Hassan, Hoda Shokri, and Ramy Khorshed. "Efficacy of Histidine–Tryptophan–Ketoglutarate Solution Versus Blood Cardioplegia in Cardiac Surgical Procedures: A Randomized Controlled | Parallel Group Study." Heart Surgery Forum 24, no. 1 (February 17, 2021): E170—E176. http://dx.doi.org/10.1532/hsf.3495.

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Background: In cardiac surgery, myocardial protection is required during cross-clamping followed by reperfusion. The use of cardioplegic solutions helps preserve myocardial energy stores, hindering electrolyte disturbances and acidosis during periods of myocardial ischaemia. This study aimed to compare the efficacy and safety between the histidine–tryptophan–ketoglutarate (HTK) solution and blood cardioplegia in various cardiac surgeries. Methods: Three-hundred-twenty patients aged 30-70 years old undergoing various cardiac surgeries were randomized into the HTK group and the blood cardioplegia group. The ventilation time, total bypass time, cross-clamp time, length of intensive care unit (ICU) or hospital stay, and postoperative complications were analyzed. Results: The total bypass time and cross-clamp time were significantly shorter in the HTK group than in the blood cardioplegia group (P < 0.001). Segmental wall motion abnormalities (SWMA) at postoperative echocardiography were significantly higher in in the blood cardioplegia group (P = 0.008). The number of patients requiring DC Shock was significantly higher in the HTK group (P < 0.001). The number of patients requiring inotropic support was significantly higher in the blood cardioplegia group (P < 0.001). The length of ICU, hospital stay, and ventilation time were significantly longer in the blood cardioplegia group than in the HTK group (P = 0.004, P < 0.001, P < 0.001, respectively). The number of patients requiring prolonged ventilation was significantly higher in the blood cardioplegia group compared with the HTK group (P = 0.022). There was no significant difference between the study groups regarding electrocardiographic changes, 30-day mortality, and 30-day readmission. Conclusion: The use of HTK cardioplegia was associated with significantly shorter cross-clamp time, bypass time, duration of mechanical ventilation, length of ICU stay, and length of hospital stay. It is associated with less incidence of postoperative segmental wall abnormalities and less need for inotropic support than blood cardioplegia. Custodiol cardioplegia is a safe and feasible option that can be used as an effective substitute for blood cardioplegia to enhance myocardial protection.

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Bignami, Elena, Marcello Guarnieri, Annalisa Franco, Chiara Gerli, Monica De Luca, Fabrizio Monaco, Giovanni Landoni, and Alberto Zangrillo. "Esmolol before cardioplegia and as cardioplegia adjuvant reduces cardiac troponin release after cardiac surgery. A randomized trial." Perfusion 32, no. 4 (December 5, 2016): 313–20. http://dx.doi.org/10.1177/0267659116681437.

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Background: Cardioplegic solutions are the standard in myocardial protection during cardiac surgery, since they interrupt the electro-mechanical activity of the heart and protect it from ischemia during aortic cross-clamping. Nevertheless, myocardial damage has a strong clinical impact. We tested the hypothesis that the short-acting beta-blocker esmolol, given immediately before cardiopulmonary bypass and as a cardioplegia additive, would provide an extra protection to myocardial tissue during cardiopulmonary bypass by virtually reducing myocardial activity and, therefore, oxygen consumption to zero. Materials and methods: This was a single-centre, double-blind, placebo-controlled, parallel-group phase IV trial. Adult patients undergoing elective valvular and non-valvular cardiac surgery with end diastolic diameter >60 mm and ejection fraction <50% were enrolled. Patients were randomly assigned to receive either esmolol, 1 mg/kg before aortic cross-clamping and 2 mg/kg with Custodiol® crystalloid cardioplegia or equivolume placebo. The primary end-point was peak postoperative troponin T concentration. Troponin was measured at Intensive Care Unit arrival and at 4, 24 and 48 hours. Secondary endpoints included ventricular fibrillation after cardioplegic arrest, need for inotropic support and intensive care unit and hospital stay. Results: We found a reduction in peak postoperative troponin T, from 1195 ng/l (690–2730) in the placebo group to 640 ng/l (544–1174) in the esmolol group (p=0.029) with no differences in Intensive Care Unit stay [3 days (1-6) in the placebo group and 3 days (2-5) in the esmolol group] and hospital stay [7 days (6–10) in the placebo group and 7 days (6–12) in the esmolol group]. Troponin peak occurred at 24 hours for 12 patients (26%) and at 4 hours for the others (74%). There were no differences in other secondary end-points. Conclusions: Adding esmolol to the cardioplegia in high-risk patients undergoing elective cardiac surgery reduces peak postoperative troponin levels. Further investigation is necessary to assess esmolol effects on major clinical outcomes.

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De Palo, Micaela, Pietro Guida, Florinda Mastro, Daniela Nanna, Teresa A. P. Quagliara, Ruggiero Rociola, Giosuè Lionetti, and Domenico Paparella. "Myocardial protection during minimally invasive cardiac surgery through right mini-thoracotomy." Perfusion 32, no. 3 (November 14, 2016): 245–52. http://dx.doi.org/10.1177/0267659116679249.

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Background: Myocardial damage is an independent predictor of adverse outcome following cardiac surgery and myocardial protection is one of the key factors to achieve successful outcomes. Cardioplegia with Custodiol is currently the most used cardioplegia during minimally invasive cardiac surgery (MICS). Different randomized controlled trials compared blood and Custodiol cardioplegia in the context of traditional cardiac surgery. No data are available for MICS. Aim: The aim of this study was to compare the efficacy of cold blood versus Custodiol cardioplegia during MICS. Method: We retrospectively evaluated 90 patients undergoing MICS through a right mini-thoracotomy in a three-year period. Myocardial protection was performed using cold blood (44 patients, CBC group) or Custodiol (46 patients, Custodiol group) cardioplegia, based on surgeon preference and complexity of surgery. Results: The primary outcomes were post-operative cardiac troponin I (cTnI) and creatine kinase MB (CKMB) serum release and the incidence of Low Cardiac Output Syndrome (LCOS). Aortic cross-clamp and cardiopulmonary bypass times were higher in the Custodiol group. No difference was observed in myocardial injury enzyme release (peak cTnI value was 18±46 ng/ml in CBC and 21±37 ng/ml in Custodiol; p=0.245). No differences were observed for mortality, LCOS, atrial or ventricular arrhythmias onset, transfusions, mechanical ventilation time duration, intensive care unit and total hospital stay. Conclusions: Custodiol and cold blood cardioplegic solutions seem to assure similar myocardial protection in patients undergoing cardiac surgery through a right mini-thoracotomy approach.

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Drury, Nigel E., Angela Horsburgh, Rehana Bi, Robert G. Willetts, and Timothy J. Jones. "Cardioplegia practice in paediatric cardiac surgery: a UK & Ireland survey." Perfusion 34, no. 2 (August 10, 2018): 125–29. http://dx.doi.org/10.1177/0267659118794343.

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Introduction: Many techniques are available for cardioplegic arrest in children, but there is a lack of late phase clinical trials to guide practice. We surveyed paediatric cardiac surgeons and perfusionists to establish current practice and willingness to change within a clinical trial. Methods: An online survey was sent to all consultant paediatric cardiac surgeons and chief perfusionists in paediatric centres in the UK and Ireland. Information was sought on cardioplegia type, composition, temperature, topical cooling, dosing for induction and maintenance, interval between doses, whether practice changed with patient age or complexity and whether respondents would be willing and able to use different cardioplegia solutions within a randomised trial. Results: Responses were obtained from 32 (78.0%) surgeons and 12 (100%) perfusionists. Twenty-seven (84.4%) surgeons use blood cardioplegia in infants, with St. Thomas’ Harefield preparation the most popular (19, 59.4%), used routinely in eight (66.7%) centres. Twenty-two (68.8%) administer at 4-6°C, 18 (56.3%) use topical cooling, 18 (56.3%) give 30 ml/kg induction and 15 ml/kg maintenance, with 23 (71.9%) re-dosing every 20-25 minutes. Thirty (93.8%) surgeons were open to randomising patients in a trial, with del Nido (29, 90.6%) the most popular. Conclusions: This survey demonstrates heterogeneity in cardioplegia practice. Whilst most surgeons use blood cardioplegia, there is variation in type, temperature, topical cooling, dosing and intervals. Combined with a lack of evidence from late phase trials, our findings support the presence of clinical equipoise. Surgeons are willing to change practice, suggesting that a pragmatic, multi-centre, randomised, controlled trial of cardioplegia in children is feasible.

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Galagudza, M. M., S. M. Minasian, Yu V. Dmitriev, Ya I. Poleshenko, P. Yu Shubina, E. S. Protsak, I. S. Uskov, D. L. Sonin, A. A. Kutenkov, and T. D. Vlasov. "Comparison of hemodynamic and infarct-limiting effects of preservation solution based on Krebs–Henseleit buffer and HTK solution in the rat model of heterotopic heart transplantation." "Arterial’naya Gipertenziya" ("Arterial Hypertension") 25, no. 1 (March 30, 2019): 84–89. http://dx.doi.org/10.18705/1607-419x-2019-25-1-84-89.

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Objective. To compare the cardioprotective effcacy of a preservation solution based on Krebs–Henseleit buffer and HTK solution in the model of heterotopic heart transplantation in rat.Design and methods. A study was conducted on 12 Wistar rats. The animals were divided into groups depending on the preservation solution used: 1) Krebs–Henseleit buffer-based solution (n = 7), 2) HTK (n = 5). Each experiment consisted of collecting donor heart, preserving it with an appropriate cardioplegic solution, heterotopic transplantation into a recipient rat followed by explantation and evaluation of left ventricular contractility using the Langendorff model and histochemical assessment of the irreversible myocardial damage. Coronary blood ﬂow in the donor heart was assessed in vivo using ultrasound doppler ﬂowmetry. After 3 hours, the donor heart was explanted and connected to the Langendorff apparatus to assess left ventricular contractility, and the myocardium was subjected to histochemical staining with 1 % triphenyltetrazolium chloride for the assessment of the irreversible myocardial damage.Results. In the group of Krebs–Henseleit buffer-based cardioplegic solution, 7 experiments were performed. Myocardial infarct size was 3,5 ± 1,2%, the coronary ﬂow rate was 4,5 ± 1,3 ml/min, and the developed left ventricular pressure of the donor heart was 70 ± 6,3 mmHg at diastolic left ventricular pressure of 10 mmHg. In the HTK solution group (n = 5), in all of the experiments after the start of blood ﬂow, the transplanted heart did not begin to contract, and all 5 hearts remained in an asystole state. Therefore, after the end of the 3-hour reperfusion period, the assessment of the contractility of the left ventricle using the Langendorff apparatus was not carried out. Coronary ﬂow rate was only 0,4 ± 0,1 ml/min, probably resulting from inadequate cardioprotection with HTK solution. Due to the lack of adequate reperfusion, the accurate assessment of the irreversible myocardial damage was impossible in the HTK solution group.Conclusions. The technique of heterotopic heart transplantation in rats is adequate and informative for the study of ischemia-reperfusion myocardial damage as well as for the study of the effectiveness of cardioplegic and cardiac preservation solutions. Cardioplegic solution based on Krebs– Henseleit buffer demonstrated greater cardioprotective effectiveness in our model compared to HTK solution.

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Tapar, Hakan, Ziya Kaya, Mustafa Suren, Semih Arici, and Serkan Karaman. "Retrospective Evaluation of Different Cardioplegic Solutions in Open Heart Surgery." Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society 17, no. 4 (July 30, 2012): 81–90. http://dx.doi.org/10.5222/gkdad.2011.081.

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Menasche, Philippe, Christian Grousset, Yann Gauduel, and Armand Piwnica. "A comparative study of free radical scavengers in cardioplegic solutions." Journal of Thoracic and Cardiovascular Surgery 92, no. 2 (August 1986): 264–71. http://dx.doi.org/10.1016/s0022-5223(19)35907-0.

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Silverman, Norman A., Ruel Wright, Sidney Levitsky, Gregory Schmitt, and Harold Feinberg. "Efficacy of crystalloid cardioplegic solutions in patients undergoing myocardial revascularization." Journal of Thoracic and Cardiovascular Surgery 89, no. 1 (January 1985): 90–96. http://dx.doi.org/10.1016/s0022-5223(19)38853-1.

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Chiavarelli, R., G. Macchiarelli, G. Familiari, M. Chiavarelli, A. Macchiarelli, P. Del Basso, B. Marino, and P. Motta. "Ultrastructural Changes of Coronary Artery Endothelium Induced by Cardioplegic Solutions." Thoracic and Cardiovascular Surgeon 37, no. 03 (June 1989): 151–57. http://dx.doi.org/10.1055/s-2007-1020308.

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Martinez-Leon, J., C. Carbonell, and J. Ortega. "A New Technical Approach For Retrograde Administration of Cardioplegic Solutions." Thoracic and Cardiovascular Surgeon 37, no. 06 (December 1989): 372–73. http://dx.doi.org/10.1055/s-2007-1020356.

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VONOPPELL, U. "Effect of pH shifts induced by oxygenating crystalloid cardioplegic solutions." Journal of Molecular and Cellular Cardiology 22 (July 1990): 13. http://dx.doi.org/10.1016/0022-2828(90)90163-v.

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von Oppell, U. O., L. M. King, E. F. Du Toit, P. Owen, B. Reichart, and L. H. Opie. "Effect of pH shifts induced by oxygenating crystalloid cardioplegic solutions." Annals of Thoracic Surgery 52, no. 4 (October 1991): 903–7. http://dx.doi.org/10.1016/0003-4975(91)91253-r.

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Pavey, Warren, Anthea Raisis, Ben Dunne, Els Van Laeken, Charles Jenkinson, Viji Vincent, Peter Baird, et al. "The practicalities of establishing a porcine isolated heart model." Perfusion 33, no. 5 (December 22, 2017): 363–66. http://dx.doi.org/10.1177/0267659117746232.

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Background: The isolated heart apparatus is over 100 years old, but remains a useful research tool today. While designs of many large animal systems have been described in the literature, trouble-shooting and refining such a model to yield a stable, workable system has not been previously described. This paper outlines the issues, in tabular form, that our group encountered in developing our own porcine isolated heart rig with the aim of assisting other workers in the field planning similar work. The paper also highlights some of the modern applications of the isolated heart apparatus. Methods Landrace pigs (50-80 kg) were used in a pilot project to develop the model. The model was then used in a study examining the effects of various cardioplegic solutions on function after reanimation of porcine hearts. During the two projects, non-protocol issues were documented as well as their solutions. These were aggregated in this paper. Results: Issues faced by the group without explicit literature solutions included pig size selection, animal acclimatisation, porcine transoesophageal echocardiography, cannulation and phlebotomy for cross-clamping, cardioplegia delivery, heart suspension and rig tuning. Conclusion: Prior recognition of issues and possible solutions faced by workers establishing a porcine isolated heart system will speed progress towards a useable system for research. The isolated heart apparatus remains applicable in transplant, ischaemia reperfusion, heart failure and organ preservation research.

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F. El-Safty, Mahmoud, Hazem Gamal Bakr, Mohamed Abd El-Hady, and Yahia Mahmoud. "COMPARISON STUDY: INTERMITTENT ANTIGRADE WARM CARDIOPLEGIA VERSUS ANTIGRADE COLD INTERMITTENT BLOOD CARDIOPLEGIA FOR MYOCARDIAL PROTECTION DURING ELECTIVE ON PUMP CORONARY ARTERY BYPASS GRAFTING IN EARLY POST-OPERATIVE PERIOD." International Journal of Advanced Research 8, no. 10 (October 31, 2020): 612–23. http://dx.doi.org/10.21474/ijar01/11884.

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Background: Defending the heart against potential damage during cross-clamping is the most important and vital step to ensuring a successful surgical outcome(1). The creation of cardioplegia solutions was one of the major advances in cardiac surgery that allowed surgeons to conduct complicated surgical procedures to avoid myocardial injury (14). Treating cardioplegia at a cool temperature would be a significant factor in lowering myocardial metabolism. However, the reduction in myocardial metabolism due to hypothermia, compared with that achieved by diastolic arrest, is usually very negligible. Since Normothermias enzymatic and cellular processes work better (7). Owing to the propensity of the heart to resume electrical operation during normothermia, however, this must be administered consistently or only with short interruptions (4). Terminal warm blood cardioplegia (hot shot) is normally done just before the elimination of the aortic cross-clamp since it has been demonstrated that myocardial metabolism is increasing (23). Methods: A prospective controlled randomised study (200 hundred patients aged 40 to 65 years of both sexes underwent elective CABG pump surgery) will be included. They will be divided into three groups of patients: Group I:includes 100 Patients who received intermittent cold blood cardioplegia. Group II:includes 100 Patients who received intermittent warm blood cardioplegia with controlled reperfusion for 3 minutes before aortic unclamping. Study made from January, 2019 to August, 2020, at National Heart Institute.All patients were thoroughly evaluated preoperatively, intraoperatively, and postoperatively. Results: We hypothesized that in our patient cohort, warm blood cardioplegia could be as successful as or even better than the conventional antegrade cold blood cardioplegia. Patients were randomised into two similar blocks, each of which consisted of 100 patients, each of whom obtained one of the two cardioplegic solutions. Our analysis did not indicate a statistically important difference in the post-operative release of myocardial biomarkers (Troponin I) & CK in both classes. This finding did not significantly reflect the clinical outcome of our patient, which may indicate similar myocardial protection in primary low-risk CABG patients for both cold and warm blood cardioplegia. Conclusion: During the time of cardiac arrest, both methods tend to enable an equal and adequate approach for myocardial defence. To attain improved myocardial defence, warm blood cardioplegia needs a shorter administration interval. Therefore, the choice between one type of cardioplegia and the other remains at the discretion of the surgeon. The statistically minor variation found in the release of myocardial enzymes did not translate into distinct clinical results.

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Menasché, P., and A. Piwnica. "The effects of retrograde perfusion of cardioplegic solutions in cardiac operations." Journal of Thoracic and Cardiovascular Surgery 92, no. 3 (September 1986): 457–58. http://dx.doi.org/10.1016/s0022-5223(19)35804-0.

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Miller, Lucinda G., and S. Neal Gardner. "Use of sodium bicarbonate vials or syringes to buffer cardioplegic solutions." American Journal of Health-System Pharmacy 43, no. 6 (June 1, 1986): 1416–20. http://dx.doi.org/10.1093/ajhp/43.6.1416.

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Pisarenko, O. I., V. S. Shul’zhenko, and I. M. Studneva. "Efficiency of cardioplegic solutions containing L-arginine and L-aspartic acid." Bulletin of Experimental Biology and Medicine 141, no. 4 (April 2006): 410–13. http://dx.doi.org/10.1007/s10517-006-0185-1.

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Mankad, Pankaj S., Adrian H. Chester, and Magdi H. Yacoub. "Role of potassium concentration in cardioplegic solutions in mediating endothelial damage." Annals of Thoracic Surgery 51, no. 1 (January 1991): 89–93. http://dx.doi.org/10.1016/0003-4975(91)90457-2.

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Takemoto, Naoaki, Hiroaki Kuroda, Takafumi Hamasaki, Yohichi Hara, Shingo Ishiguro, and Tohru Mori. "Effect of magnesium and calcium on myocafdial protection by cardioplegic solutions." Annals of Thoracic Surgery 57, no. 1 (January 1994): 177–82. http://dx.doi.org/10.1016/0003-4975(94)90389-1.

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Aoki, Mitsuru, Fumikazu Nomura, and John E. Mayer. "Interactions between preischemic hypothermia and cardioplegic solutions in the neonatal lamb heart." Journal of Thoracic and Cardiovascular Surgery 107, no. 3 (March 1994): 822–28. http://dx.doi.org/10.1016/s0022-5223(94)70338-8.

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