Dj. Chambers et al., ST-THOMAS-HOSPITAL CARDIOPLEGIA - ENHANCED PROTECTION WITH EXOGENOUS CREATINE-PHOSPHATE, The Annals of thoracic surgery, 61(1), 1996, pp. 67-75
Background. Experimentally, creatine phosphate (CP) improves postische
mic recovery of function and reduces postischemic arrhythmias. Methods
. We studied 50 patients undergoing valve replacement. They were rando
mized into either a control group, who received St. Thomas' Hospital c
ardioplegic solution No. 1, or a CP-treated group, receiving the same
cardioplegic solution plus CP (10 mmol/L). There were no preoperative
clinical differences between groups. Assessment was by electrocardiogr
aphic analysis, inotropic drug requirement, quantitative birefringence
, myocardial high-energy phosphate content, function, and semiquantita
tive ultrastructural assessment. Results. Direct-current shocks were r
educed in the CP-treated group (0.88 +/- 0.15) compared with the contr
ol group (1.40 +/- 0.14; p < 0.02), as was the total number of joules
(22.0 +/- 3.5 versus 34.4 +/- 3.7, respectively; p < 0.02). The incide
nce of spontaneous sinus rhythm was higher in the CP-treated group (40
% versus 8%; p < 0.05) and the incidence of postoperative arrhythmias,
lower (8% versus 32%; p < 0.05). Prolonged inotropic administration (
12 hours or longer) occurred in fewer patients in the CP-treated group
(4% versus 28%; p < 0.05). Response to inotropic support (in the subs
et of patients requiring this treatment) was significantly greater in
the CP-treated group than in the control group. There were no differen
ces in recovery of function, birefringence changes, myocardial high-en
ergy phosphate content, or ultrastructure between groups. Conclusions.
St. Thomas' Hospital cardioplegic solution No. 1 plus CP enhanced myo
cardial protection and conferred a direct benefit to the patient by re
ducing postoperative arrhythmias and need of prolonged inotropic suppo
rt.