Clinical validation of St. Thomas' Hospital cardioplegic solution No.2 (Plegisol)

Abstract

Recently, the St. Thomas' Hospital cardioplegic solution No. 2(Plegisol) has become available commercially in the UK. In a series ofpatients (n = 28) undergoing open heart surgery for a variety of lesions, aclinical validation was performed. Preservation of myocardial contractilitywas assessed biophysically by quantitative birefringence measurements ofmyocardial biopsy samples (full thickness apical left ventricle and rightventricle) taken (1) prior to ischaemia, (2) at the end of ischaemia and(3) 10-15 min after reperfusion during cardiopulmonary bypass. In addition,serum CK-MB values were measured in samples taken throughout the operationand for 4 days postoperatively. Postoperative ECG traces (taken every 6 hfor 48 h and then daily up to 7 days) were analysed to identify theoccurrence of perioperative infarction. There were no hospital deaths.Chronotropic support was required in 5 of 28 patients (18%) for transientheart block. Low cardiac output did not occur postoperatively.Birefringence measurements in biopsy samples taken at the end of theischaemic period (immediately prior to reperfusion) indicated an apparentleft ventricular deterioration in myocardial contractility in 12 of 28patients (43%) when compared to biopsies sampled prior to the ischaemicperiod. However, after 10-15 min of aerobic reperfusion, measurementsindicated that myocardial contractility recovered to almost pre-ischaemiclevels in the majority of patients. Thus, in 22 of 28 patients (79%), leftventricular deterioration did not occur in post-ischaemic biopsy sampleswhen compared to the pre-ischaemic biopsies. Similarly, 21 of 28 patients(75%) had no deterioration of birefringence values in right ventricularbiopsies.(ABSTRACT TRUNCATED AT 250 WORDS)