Outcome of esmolol potassium cardioplegia compared to potassium cardioplegia in patients with solitary valvular disease

Abstract

Perioperative myocardial damage still one of the main serious complications of cardiac
surgery, many factors have been involved through the pathogenesis procedure, involving the
technique of cardiac surgery, creation of cardioplegia and duration of cardiac arrest (1, 2). It
has been well reported that precocious management of beta-adrenergic antagonist through
cardiopulmonary bypass (CPB) or during ten minutes following liberation of aortic clamp
participates to left ventricular function (3, 4). In addition, cardioplegia included esmolol, an
ultra-short-acting (9-minute half-life) cardioselective beta blocker, has cardioprotection in
animal model and clinical clients (5, 6). Esmolol, an ultra-short-acting beta-blocker, is
recognized to reduce myocardial ischemia-reperfusion damage. The purpose of this
investigation was carried out to compare the impacts of esmolol and potassium on myocardial
metabolism through hypothermic blood cardioplegia employing lactate level in the coronary
sinus as a marker. Eighty patients , with mean age of esmolol group was 39.5 while that of
the control group was 37.58,operated on for solitary valvular disease were randomly
designated to persistent coronary infusion with either potassium or esmolol through
cardiopulmonary bypass. All patients assigned into two groups, group A as esmolol group as
and group B as control group .Myocardial metabolism was assessed by serial coronary sinus
lactate level via retrograde cardioplegia cannula was derived to assess the effect of esmolol as
indicator of myocardial ischemia before aortic cross clamp, after aortic cross clamp and
immediately before aortic declamping. Also we selected our patients who have solitary
valvular lesion to ensure short time of bypass and cross-clamp, with healthy coronaries to
ensure potent delivery of cardioplegic solution however; we found no significant effects
regarding lactate release, the use of inotropes, post-operative ICU stay or LVOT VTI