Is Hot-shot Cardioplegia Necessary in Cardiac Surgery with Cardiopulmonary Bypass?

Year 2025, Volume: 6 Issue: 3, 192 - 199, 28.09.2025

Bişar Amaç , Mesut Engin , Mustafa Abanoz

https://doi.org/10.47482/acmr.1631396

Abstract

Background: Many solutions and techniques have been developed to protect the myocardium during cardiac surgery with cardiopulmonary bypass. Hot-shot cardioplegia is given during removal of the aortic cross-clamp, i.e. during restart of the heart, but its necessity and additional benefit are controversial. The aim of this retrospective study was to evaluate the necessity and/or extra benefit of hot-shot cardioplegia administration and early clinical outcomes in patients undergoing cardiac surgery with cardiopulmonary bypass.
Methods: This retrospective study included a total of 686 patients who underwent cardiac surgery with cardiopulmonary bypass. The study groups were defined as patients without hot-shot cardioplegia (Group 1) and patients with hot-shot cardioplegia (Group 2). Descriptive data and early clinical outcomes of the groups were compared.
Results: Demographic and descriptive data of the patients included in the study were similar in both groups (p > 0.05). There was no difference between the groups in potassium levels, Creatine Kinase-Myocardial Bound and Cardiac Troponin T levels indicative of myocardial necrosis, and Carbohydrate Reactive Protein levels indicative of inflammation (p > 0.05). In addition, there was no difference in the need for intracardiac defibrillation, inotrope requirement during cardiopulmonary bypass weaning, intra-aortic balloon pump requirement, early postoperative arrhythmia, atrial fibrillation, duration of mechanical ventilation, intensive care unit stay, hospital stay and mortality rates (p > 0.05).
Conclusion: In conclusion, it is thought that hot-shot cardioplegia application does not provide any additional benefit in preventing myocardial damage or in postoperative clinical and metabolic markers in cardiac surgery performed with cardiopulmonary bypass.

Keywords

Cardiopulmonary Bypass , Cardioplegia , Hot-Shot , Terminal Hot Blood Cardioplegia

Ethical Statement

In this study, approval was obtained from the institution and the local ethics committee before the study (Harran University Clinical Research Ethics Committee) (Date: 30.12.2024 - Approval no: HRÜ/24.21.11). The study was conducted following the principles of the Declaration of Helsinki. Since only anonymized patient data was used and there was no risk or impact on patient care, informed consent was not required. This consent waiver was approved by the Institutional Review Board and Ethics Committee and complies with regulatory and ethical guidelines for retrospective studies.

Supporting Institution

The authors received no financial support for the research and/or authorship of this article. There is no funding source.

Thanks

None

Kardiyopulmoner Bypass Eşliğinde Yapılan Kalp Cerrahisinde Hot-shot Kardiyoplejisi Gerekli midir?

Abstract

Giriş: KPB eşliğinde yapılan kalp cerrahisinde miyokardı korumak için çok sayıda solüsyon ve teknik tanıtılmıştır. Hot-shot kardiyoplejisi de aortik kross klembin kaldırılması sırasında yani kalbin yeniden çalıştırılması sırasında verilmekle beraber, gerekliliği ve ekstra fayda sağlama konusu tartışmalıdır. Bu retrospektif çalışmada KPB eşliğinde kardiyak cerrahi uygulanmış hastalarda hot-shot kardiyopleji uygulamasının gerekliliği ve/veya ekstra fayda sağlayıp sağlamadığı ve erken dönem klinik sonuçlarının değerlendirilmesi amaçlanmaktadır.
Yöntem: Bu retrospektif çalışmaya KPB eşliğinde kardiyak cerrahi uygulanan toplam 686 hasta verisi dahil edildi. Çalışma grupları hot-shot kardiyoplejisi kullanılmayan (Grup 1) ve hot shot kardiyoplejisi kullanılan hastalar (Grup 2) olarak belirlendi. Grupların tanımlayıcı verileri ve erken dönem klinik sonuçları karşılaştırıldı.
Bulgular: Çalışmaya dahil edilen hastaların demografik ve tanımlayıcı verileri her iki grupta da benzerdi (p > 0.05). Grupların potasyum düzeyi, miyokardiyal nekroz göstergesi olan CK-MB ve CTnT düzeyleri ve inflamasyon göstergesi olan CRP düzeyleri arasında fark yoktu (p > 0.05). Ayrıca intrakardiyak defibrilasyon ihtiyacı, KPB weaning sırasındaki inotrop ihtiyacı, IABP ihtiyacı, erken dönem postoperatif aritmi, AF, mekanik ventilasyon süresi, ICU kalış süresi, hastanede kalış süreleri ve mortalite oranları arasında fark gözlenmedi (p > 0.05).
Sonuç: Sonuç olarak hot-shot kardiyopleji uygulaması kardiyopulmoner bypass eşliğinde yapılan kalp cerrahisinde miyokardiyal hasarı önlemede veya postoperatif klinik ve metabolik belirteçlerde herhangi bir ekstra fayda sağlamadığı düşünülmektedir.

Keywords

Kardiyopulmoner Bypass , Kardiyopleji , Hot-Shot , Terminal Sıcak Kan Kardiyoplejisi

Ethical Statement

In this study, approval was obtained from the institution and the local ethics committee before the study (Harran University Clinical Research Ethics Committee) (Date: 30.12.2024 - Approval no: HRÜ/24.21.11). The study was conducted following the principles of the Declaration of Helsinki. Since only anonymized patient data was used and there was no risk or impact on patient care, informed consent was not required. This consent waiver was approved by the Institutional Review Board and Ethics Committee and complies with regulatory and ethical guidelines for retrospective studies.

Supporting Institution

None

References

• James TM, Nores M, Rousou JA, Lin N, Stamou SC. Warm Blood Cardioplegia for Myocardial Protection: Concepts and Controversies. Tex Heart Inst J. 2020;47(2):108-16.
• Russell S, Butt S, Vohra HA. In search of optimal cardioplegia for minimally invasive valve surgery. Perfusion. 2022;37(7):668-74.
• Chan J, Oo S, Butt S, Benedetto U, Caputo M, Angelini GD, et al. Network meta-analysis comparing blood cardioplegia, Del Nido cardioplegia and custodiol cardioplegia in minimally invasive cardiac surgery. Perfusion. 2023;38(3):464-72.
• Saclı H, Kara I, Diler MS, Percin B, Turan AI, Kırali K. The Relationship between the Use of Cold and Isothermic Blood Cardioplegia Solution for Myocardial Protection during Cardiopulmonary Bypass and the Ischemia-Reperfusion Injury. Ann Thorac Cardiovasc Surg. 2019;25(6):296-303.
• Li C, Xiang H, Yang H, Liu W, Lan W, Luo C, et al. Del Nido cardioplegia versus cold blood cardioplegia in adult cardiac surgery: a meta-analysis of randomized clinical trials. J Cardiothorac Surg. 2024;19(1):356.
• von Zeppelin M, Hecker F, Keller H, Hlavicka J, Walther T, Moritz A, et al. Gradual Reperfusion in Cardioplegia-Induced Cardiac Arrest. Medicina (Kaunas). 2024;60(10):1564.
• Al-Hasan-Al-Saegh S, Takemoto S, Benenati S, Shafiei S, Yavuz S, Galli M, et al. Optimizing Myocardial Protection in Minimally Invasive Cardiac Surgeries: A Network Comparison of Del Nido, Histidine-Tryptophan-Ketoglutarate, and Blood Cardioplegia. J Clin Med. 2024;13(22):6977.
• Mirmohammadsadeghi P, Mirmohammadsadeghi M. Effects of single antegrade hot shot in comparison with no hot shot administration during coronary artery bypass grafting. ARYA Atheroscler. 2015;11(3):186-90.
• Karaarslan K, Abud B. Effects of Del Nido and Terminal Warm Blood Cardioplegia on Myocardial Protection and Rhythm in Isolated CABG Patients. Heart Surg Forum. 2021;24(5):E808-13.
• Elgariah M, El Nasr MA, Fawzy H, Wahby E, Taha A. Effect of terminal warm reperfusion (hot shot) and remote ischemic preconditioning, either separately or combined, on myocardial recovery in adult cardiac surgery. J Egypt Soc Cardio-Thorac Surg. 2017;25(3):230-35.
• Skeffington KL, Moscarelli M, Abdul-Ghani S, Fiorentino F, Emanueli C, Reeves BC, et al. Pathology-related changes in cardiac energy metabolites, inflammatory response and reperfusion injury following cardioplegic arrest in patients undergoing open-heart surgery. Front Cardiovasc Med. 2022;9:911557.
• Busro PW, Romolo H, Sastroasmoro S, Rachmat J, Sadikin M, Santoso A, et al. Role of terminal warm blood cardioplegia in complex congenital heart surgery. Asian Cardiovasc Thorac Ann. 2018;26(3):196-202.
• Edwards R, Treasure T, Hossein-Nia M, Murday A, Kantidakis GH, Holt DW. A controlled trial of substrate-enhanced, warm reperfusion (“hot shot”) versus simple reperfusion. Ann Thorac Surg. 2000;69(2):551-5.
• Ascione R, Suleiman SM, Angelini GD. Retrograde hot-shot cardioplegia in patients with left ventricular hypertrophy undergoing aortic valve replacement. Ann Thorac Surg. 2008;85(2):454-8.
• Volpi S, Ali JM, De Silva R. Does the use of a hot-shot lead to improved outcomes following adult cardiac surgery?. Interact Cardiovasc Thorac Surg. 2019;28(3):473-7.
• Caputo M, Dihmis WC, Bryan AJ, Suleiman MS, Angelini GD. Warm blood hyperkalaemic reperfusion (‘hot shot’) prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 1998;13(5):559-64.
• Nakao M, Morita K, Shinohara G, Saito S, Kunihara T. Superior restoration of left ventricular performance after prolonged single-dose del Nido cardioplegia in conjunction with terminal warm blood cardioplegic reperfusion. J Thorac Cardiovasc Surg. 2022;164(4):e143-53.
• Zhou K, Zhang X, Li D, Song G. Myocardial Protection With Different Cardioplegia in Adult Cardiac Surgery: A Network Meta-Analysis. Heart Lung Circ. 2022;31(3):420-9.