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Thorac Cardiovasc Surg
DOI: 10.1055/a-2618-4744
Original Cardiovascular

Experimental Comparison of Esmolol- and Blood-Based Cardioplegia for Long Aortic Clamping Times

Andreas Böning
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
,
Balli Chapugi
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
,
Martina Heep
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
,
Ulrich Gärtner
2   Institute of Anatomy, Justus Liebig Universitat Giessen, Giessen, Hessen, Germany
,
Bernd Niemann
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
,
Zulfugar T. Taghiyev 
1   Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
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Abstract

Objectives

After cardiac surgery, long aortic clamping times and extracorporeal circulation times are associated with worse outcomes. This study compares hemodynamic performance, myocardial metabolism, and ultrastructural preservation in rat hearts after applying esmolol crystalloid cardioplegia (ECCP) or Calafiore blood cardioplegia (Cala).

Materials and Methods

Hearts from 18 Wistar rats were perfused in a Langendorff system. Following 120 minutes of ischemia at 36 °C, hearts received either ECCP at 32 °C for 3 minutes or Cala at 36 °C for 2 minutes every 20 minutes. During 90 minutes of reperfusion, coronary blood flow (CF), left ventricular developed pressure (LVDP), and contraction/relaxation velocities (±dp/dt) were recorded. Myocardial oxygen consumption, lactate production, and troponin I levels were measured. Electron microscopy was used for ultrastructural assessment.

Results

Baseline (BL) values of LVDP, CF, and ±dp/dt were similar between the two groups. After 90 minutes of reperfusion, CF was significantly higher in the ECCP group: 85 ± 43% of BL in the ECCP group versus 42 ± 24% of BL in the Cala group (p = 0.002). At the end of reperfusion, hearts exposed to ECCP had higher LVDP (91 ± 40%) values than Cala (43 ± 10%), indicating improved cardiac recovery with ECCP. Myocardial contraction and relaxation were notably better in the ECCP group: dLVP/dtmax was 111 ± 40% versus 59 ± 13% in the Cala group (p = 0.002), and dLVP/dtmin was 88 ± 34% versus 40 ± 7% (p = 0.001). Troponin I levels measured in Cala hearts at the end of reperfusion were higher than in ECCP hearts (Cala 1,102.6 ± 361.3 ng/mL vs. ECCP 442.3 ± 788.4 ng/mL, p = 0.036).

Conclusion

In rat hearts, ECCP offers better hemodynamic recovery and protects the myocardium from ischemia/reperfusion-related damage, better than Cala blood cardioplegia, even with aortic clamping times of 120 minutes.

Keywords

esmolol cardioplegia - blood cardioplegia - myocardial protection - ischemia–reperfusion injury

Note

This study was presented at the 53rd annual meeting of the German Society of Thoracic and Cardiovascular Surgery, 18 February 2024, Hamburg, Germany.


Data Availability Statement

The data underlying this manuscript will be shared by the corresponding author upon reasonable request.


Authors' Contribution

A.B. contributed to conceptualization; data curation; acquisition of study; investigation; methodology; supervision; validation; visualization; writing—original draft. B.C. contributed to data—collection, validation, and curation; formal analysis; writing—review and editing. M.H. contributed to data—collection, validation, and curation; formal analysis. U.G. contributed to conceptualization; project administration; data curation; investigation; methodology; supervision; validation; writing—review and editing. B.N. contributed to supervision; writing—review and editing. Z.T.T. contributed to data curation; formal analysis; data validation; visualization; writing—review and editing.




Publication History

Received: 06 February 2025

Accepted: 20 May 2025

Accepted Manuscript online:
22 May 2025

Article published online:
10 June 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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