Cardioplegia.pptx

cardioplegia solutions comparison.

1. C ardioplegia 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 D elnido 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 I nduction 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..