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Nutraceutical Application of Creatine
Published in Robert E.C. Wildman, Richard S. Bruno, Handbook of Nutraceuticals and Functional Foods, 2019
Richard B. Kreider, Douglas S. Kalman, Jose Antonio, Tim N. Ziegenfuss, Robert E.C. Wildman, Darren G. Candow, Chad M. Kerksick
Creatine and phosphocreatine play an important role in maintaining myocardial bioenergetics during ischemic events.57 For this reason, there has been interest in assessing the role of creatine or phosphocreatine in reducing arrhythmias and/or improving heart function during ischemia.161–170 In this respect, Balestrino and colleagues57 concluded that phosphocreatine administration, primarily as an addition to cardioplegic solutions, has been used to treat myocardial ischemia and prevent ischemia-induced arrhythmia while improving cardiac function, with some success. They suggested that creatine supplementation may protect the heart during an ischemic event. Thus, prophylactic creatine supplementation may be beneficial for patients at risk for myocardial ischemia and/or stroke.
Cardiac surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Cardioplegic solutions vary in terms of temperature, pH, arresting agent, osmolality and the presence of red cells and other factors. Most solutions contain potassium as the arresting agent. Potassium arrests the heart in diastole by depolarisation of the myocyte cellular membrane. Cold (4-10°C) isotonic crystalloid or blood solutions aid myocardial protection by reducing metabolic requirements through local hypothermia. Warm cardioplegic solutions, on the other hand, may facilitate better myocardial repair recovery postoperatively by aiding activation of intramyocardial enzymes.
Coronary Circulation
Published in Lara Wijayasiri, Kate McCombe, Paul Hatton, David Bogod, The Primary FRCA Structured Oral Examination Study Guide 1, 2017
Lara Wijayasiri, Kate McCombe, Paul Hatton, David Bogod
Factors that determine myocardial oxygen consumption include heart rate, contractility, afterload, tissue mass and temperature (cold cardioplegic solutions are used during cardiopulmonary bypass surgery to reduce myocardial oxygen consumption and minimise risk of ischaemia).
St. Thomas and del Nido cardioplegia are superior to Custodiol cardioplegia in a rat model of donor heart
Published in Scandinavian Cardiovascular Journal, 2021
Gulsum Karduz, Muhittin Onur Yaman, Mehmet Altan, Gulderen Sahin, Fevzi Toraman, Ugur Aksu
Cardioplegic solutions provide a stable surgical area during cardiac surgery and transplantation. Another use of cardioplegic solutions is to create an immediate arrest and to preserve the tissue during an extended period of ischemia. Various solutions with different protective and chemical properties have been developed [3–5]. Ion concentrations of crystalloid cardioplegic solutions are similar to the cytoplasm as low sodium (<1.6 g/L) and high potassium (>3.9 g/L). It has been shown that hyperkalemic crystalloid cardioplegia solutions keep the cell membrane in the depolarization phase of the action potential, leading to diastolic cardiac arrest [6]. However, they may cause calcium entry into the cell and immediate vasoconstriction. Also, endothelial damage can occur following solution exposure because of the high potassium concentration. In addition, cardioplegia solutions with high sodium (>1.6 g/L) and low potassium (<0.8 g/L) concentrations increase vascular resistance and reduce endothelial damage [7,8].
Recent advances in porcine cardiac xenotransplantation: from aortic valve replacement to heart transplantation
Published in Expert Review of Cardiovascular Therapy, 2022
Sam Kavarana, Jennie H Kwon, Kasparas Zilinskas, Lillian Kang, Joseph W Turek, Muhammad M Mohiuddin, T Konrad Rajab
Ischemia, or a lack of blood while transferring an organ, is a relevant issue in the field of transplantation in general, as well as in xenotransplantation. The idea that prolonged ischemia leads to decreased graft survival is unsurprising, but the concept that reperfusion itself triggers many negative consequences is less intuitive [54]. Although the causes and mechanisms of IRI are interesting, they are unnecessary to consider in detail for the purposes of this review. Instead, it is more prudent to discuss the pathway to the current perspectives on ischemic preservation in cardiac xenotransplants. Typically, the coronary arteries are flushed with cardioplegic solution to induce cardiac stasis and the organ is stored at 4°C under ischemic conditions [55]. Ischemia lasting less than 4 hours has been associated with increased survival rates, and ischemia lasting longer than 6 hours is considered to be an increased risk factor for 1-year mortality [55]. Different cardioplegic solutions have been used in order to provide a better prognosis, but they have had mixed results, indicating that a different method is necessary to prevent ischemia-induced injury or IRI [55]. Interestingly, the rates of mortality with ischemia are drastically different in allotransplants versus xenotransplants. In human allotransplants, ischemic preservation leads to perioperative graft dysfunction rates of 3.8–7.4% [55]. However, in xenotransplants, early graft failure is much more common and creates a barrier to survival with mortality rates as high as 40–60% [56]. This leads to the coining of the term perioperative cardiac xenograft dysfunction (PCXD) by McGregor et al.
Strategies and pitfalls during minimally invasive total coronary artery revascularization via left anterior minithoracotomy: a promising future
Published in Acta Cardiologica, 2022
Mugisha Kyaruzi, Ergun Demirsoy
Cardioplegic arrest is utilised during multivessel coronary surgery via left anterior mini-thoracotomy. A chitwood DeBakay aortic clamp is placed through second intercostal space. Through out of the procedure the heart should be empty and flaccid. Conventional antegrade cold blood cardioplegia is delivered to allow cardiac arrest. Cardioplegic arrest is maintained with repeat doses given at 15- to 20-minute intervals. At the end of each distal anastomosis cardioplegia is delivered through the graft. This enables to approve the quality of runoff and any leak that may require repair. Other cardioplegic solutions such as custadiol, Del Nido may be also used during the procedure [11].