A technique avoiding cardioplegia delivery complications: a case using systemic hyperkalemia cardiopulmonary bypass combined with circulatory arrest
We conducted a high-risk redo mitral valve replacement through a right mini-thoracotomy without rib spreading (redo-MICS MVR) under systemic hyperkalemia combined with circulatory arrest to circumvent complications associated with cardioplegia delivery. The patient, a 75-year-old man, had a predicte...
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EDP Sciences
2024-12-01
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| Series: | The Journal of ExtraCorporeal Technology |
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| Online Access: | https://ject.edpsciences.org/articles/ject/full_html/2024/04/ject240014/ject240014.html |
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| author | Takeichi Tomohisa Morimoto Yoshihisa Yamada Akitoshi Tanaka Takanori |
| author_facet | Takeichi Tomohisa Morimoto Yoshihisa Yamada Akitoshi Tanaka Takanori |
| author_sort | Takeichi Tomohisa |
| collection | DOAJ |
| description | We conducted a high-risk redo mitral valve replacement through a right mini-thoracotomy without rib spreading (redo-MICS MVR) under systemic hyperkalemia combined with circulatory arrest to circumvent complications associated with cardioplegia delivery. The patient, a 75-year-old man, had a predicted mortality rate of 20%. Initial antegrade cardioplegia successfully induced cardiac arrest, which was administered every 30 min. However, upon infusion of the second dose of cardioplegia, the aortic root pressure was approximately 20 mmHg. Despite multiple attempts to re-cross the clamp, the aortic root pressure did not improve. Consequently, retrograde cardioplegia was considered, but due to significant adhesion of the inferior vena cava, this approach was abandoned. Thus, the procedure was altered to utilize systemic hyperkalemia without aortic cross-clamping (ACC). Given the preoperative transesophageal echocardiography (TEE) diagnosis of mild aortic regurgitation, maintaining a clear surgical field was challenging, necessitating the combination of redo-MVR with circulatory arrest. This case exemplifies the successful management of cardioplegia delivery complications using systemic hyperkalemia and circulatory arrest, resulting in a favorable postoperative recovery for the patient. |
| format | Article |
| id | doaj-art-5f3c7e1c337543f493c94d34f222630a |
| institution | Kabale University |
| issn | 0022-1058 2969-8960 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | EDP Sciences |
| record_format | Article |
| series | The Journal of ExtraCorporeal Technology |
| spelling | doaj-art-5f3c7e1c337543f493c94d34f222630a2025-01-08T11:00:21ZengEDP SciencesThe Journal of ExtraCorporeal Technology0022-10582969-89602024-12-0156420721010.1051/ject/2024027ject240014A technique avoiding cardioplegia delivery complications: a case using systemic hyperkalemia cardiopulmonary bypass combined with circulatory arrestTakeichi Tomohisa0https://orcid.org/0000-0003-2344-6219Morimoto Yoshihisa1Yamada Akitoshi2Tanaka Takanori3Department of Clinical Engineering, Kitaharima Medical CenterDepartment of Cardiovascular Surgery, Kitaharima Medical CenterDepartment of Cardiovascular Surgery, Kitaharima Medical CenterDepartment of Clinical Engineering, Kitaharima Medical CenterWe conducted a high-risk redo mitral valve replacement through a right mini-thoracotomy without rib spreading (redo-MICS MVR) under systemic hyperkalemia combined with circulatory arrest to circumvent complications associated with cardioplegia delivery. The patient, a 75-year-old man, had a predicted mortality rate of 20%. Initial antegrade cardioplegia successfully induced cardiac arrest, which was administered every 30 min. However, upon infusion of the second dose of cardioplegia, the aortic root pressure was approximately 20 mmHg. Despite multiple attempts to re-cross the clamp, the aortic root pressure did not improve. Consequently, retrograde cardioplegia was considered, but due to significant adhesion of the inferior vena cava, this approach was abandoned. Thus, the procedure was altered to utilize systemic hyperkalemia without aortic cross-clamping (ACC). Given the preoperative transesophageal echocardiography (TEE) diagnosis of mild aortic regurgitation, maintaining a clear surgical field was challenging, necessitating the combination of redo-MVR with circulatory arrest. This case exemplifies the successful management of cardioplegia delivery complications using systemic hyperkalemia and circulatory arrest, resulting in a favorable postoperative recovery for the patient.https://ject.edpsciences.org/articles/ject/full_html/2024/04/ject240014/ject240014.htmlcardiopulmonary bypass (cpb)systemic hyperkalemiacirculatory arrestcardioplegia delivery complications |
| spellingShingle | Takeichi Tomohisa Morimoto Yoshihisa Yamada Akitoshi Tanaka Takanori A technique avoiding cardioplegia delivery complications: a case using systemic hyperkalemia cardiopulmonary bypass combined with circulatory arrest The Journal of ExtraCorporeal Technology cardiopulmonary bypass (cpb) systemic hyperkalemia circulatory arrest cardioplegia delivery complications |
| title | A technique avoiding cardioplegia delivery complications: a case using systemic hyperkalemia cardiopulmonary bypass combined with circulatory arrest |
| title_full | A technique avoiding cardioplegia delivery complications: a case using systemic hyperkalemia cardiopulmonary bypass combined with circulatory arrest |
| title_fullStr | A technique avoiding cardioplegia delivery complications: a case using systemic hyperkalemia cardiopulmonary bypass combined with circulatory arrest |
| title_full_unstemmed | A technique avoiding cardioplegia delivery complications: a case using systemic hyperkalemia cardiopulmonary bypass combined with circulatory arrest |
| title_short | A technique avoiding cardioplegia delivery complications: a case using systemic hyperkalemia cardiopulmonary bypass combined with circulatory arrest |
| title_sort | technique avoiding cardioplegia delivery complications a case using systemic hyperkalemia cardiopulmonary bypass combined with circulatory arrest |
| topic | cardiopulmonary bypass (cpb) systemic hyperkalemia circulatory arrest cardioplegia delivery complications |
| url | https://ject.edpsciences.org/articles/ject/full_html/2024/04/ject240014/ject240014.html |
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