Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/7804
Title: Clinical and ultramicroscopic myocardial randomized study of beating versus arrested heart for mitral surgery
Authors: Cueva, Clotario Neptali Carrasco
Rocha, Maiara dos Santos
Mendes, Carlos Maurício Cardeal
Freitas, Luiz Antonio Rodrigues de
Baucia, José Augusto
Badaró, Roberto José da Silva
Affilliation: Universidade Federal da Bahia. Medical School. Salvador, BA, Brasil
Universidade Federal da Bahia. Salvador, BA, Brasil
Universidade Federal da Bahia. Instituto de Ciências da Saúde. Salvador, BA, Brasil
Universidade Federal da Bahia. Medical School. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil
Universidade Federal da Bahia. Medical School. Salvador, BA, Brasil
Universidade Federal da Bahia. Medical School. Salvador, BA, Brasil
Abstract: INTRODUCTION: Beating heart surgery on normothermic bypass simulates physiologic cardiac status. OBJECTIVES: This study compared clinical and transmission electron microscopic aspects of myocardial protection during mitral valve replacement using warm retrograde perfusion in empty beating versus arrested heart with cold blood anterograde cardioplegia. METHODS: Randomized study to evaluate myocardial cellular ischemia-reperfusion of both techniques to replace the mitral valve. Thirty-four patients were randomly assigned into group A (beating heart) and group B (arrested heart). The following parameters were assessed: echocardiography, blood chemistry, hemoglobin, lactate. During the surgical procedure a total of 102 myocardial biopsies were performed for ultrastructural analysis from anterior left ventricular wall: before cardiopulmonary bypass, before aortic desclamping and 10 minutes after reperfusion. RESULTS: Elevation of lactate at 3 hours during the procedure was higher in group A, but similar at the end of surgery (P=0.06). Cardioversion was necessary in 5/17 (A) vs. 13/17 (B) P=0.07. Median intraoperative systemic temperature was significantly lower in the group B compared to A (32° C vs. 36° C), P<0.001. There was no significant difference of the ultramicroscopic aspects of the heart biopsies before, during and after surgery in both groups. Cellular and mitochondrial transient abnormalities such as mitochondrial swelling, glycogen loss and cytosol swelling were detected independently of the moment of the biopsies. CONCLUSION: Myocardial protection and ultrastructural abnormalities were similar for both types of mitral valve replacement beating or arrested heart techniques.
Keywords: Heart Arrest
Induced
Myocardium
Mitral
Valve
Surgery
DeCS: Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos
Parada Cardíaca Induzida/métodos
Implante de Prótese de Valva Cardíaca/métodos
Valva Mitral/cirurgia
Miocárdio/patologia
Adolescente
Adulto
Biópsia
Feminino
Humanos
Ácido Láctico/sangue
Masculino
Microscopia Eletrônica de Transmissão
Meia-Idade
Valva Mitral/patologia
Miocárdio/ultraestrutura
Período Pós-Operatório
Estudos Prospectivos
Fatores de Tempo
Resultado do Tratamento
Adulto Jovem
Issue Date: 2013
Publisher: Sociedade Brasileira de Cirurgia Cardiovascular
Citation: CUEVA, C. N. C. et al. Clinical and ultramicroscopic myocardial randomized study of beating versus arrested heart for mitral surgery. Revista Brasileira de Cirurgia Cardiovascular, v. 28, n. 2, p. 270-280, 2013.
ISSN: 1678-9741
10.5935/1678-9741.20130038
Copyright: open access
Appears in Collections:BA - IGM - Artigos de Periódicos

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