Comparative Effects of Blood and Crystalloid Cardioplegia on Cellular Injury and Oxidative Stress in Cardiovascular Surgery

Ann Thorac Cardiovasc Surg. 2019 Feb 20;25(1):10-17. doi: 10.5761/atcs.oa.18-00113. Epub 2018 Aug 28.


Purpose: The purpose of this study was to evaluate the effect of different cardioplegic solutions on endothelial integrity and oxidative stress in cardiovascular surgery.

Methods: In this randomized prospective study, after ethics approval and informed consent, 60 surgical patients were included. Patients undergoing coronary bypass surgery were randomized into two groups as warm blood cardioplegia (n = 30) and cold crystalloid cardioplegia (n = 30) following the cross-clamping. Measurements were performed at three time points: before induction of anesthesia (T1), at admission to intensive care unit (ICU) (T2) and at the 24th postoperative hour (T3). Besides biochemical routine hemodynamic monitoring, patients were assessed for the sialic acid (SA), ischemic-modified albumin (IMA), advanced oxide protein products (AOPPs), total thiol (SH), and free hemoglobin (fHb) level.

Results: Neither crystalloid nor blood cardioplegia led to significant changes in the AOPPs, T-SH, and SA level (p >0.05). Crystalloid cardioplegia, however, increased IMA level compared to both baseline (p <0.01) and blood cardioplegia group (p <0.05). fHb levels were transiently increased in both groups at the second-time point (p <0.001). fHb level was lower in the crystalloid group compared to that in the other group (p <0.05) at T2.

Conclusion: Cardioplegia type creates similar effects on glycocalyx integrity. However, myocardial protection could be provided with warm blood cardioplegia.

Keywords: cardioplegic solutions; cardiovascular surgery; endothelial glycocalyx; sialic acid.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Advanced Oxidation Protein Products / blood
  • Aged
  • Biomarkers / blood
  • Cardioplegic Solutions / administration & dosage*
  • Cardioplegic Solutions / adverse effects
  • Cold Temperature
  • Coronary Artery Bypass* / adverse effects
  • Creatine Kinase, MB Form / blood
  • Endothelial Cells / drug effects*
  • Endothelial Cells / metabolism
  • Endothelial Cells / pathology
  • Female
  • Glycocalyx / drug effects*
  • Glycocalyx / metabolism
  • Glycocalyx / pathology
  • Heart Arrest, Induced / adverse effects
  • Heart Arrest, Induced / methods*
  • Hemoglobins / metabolism
  • Humans
  • Male
  • Middle Aged
  • N-Acetylneuraminic Acid / blood
  • Oxidative Stress / drug effects*
  • Potassium Compounds / administration & dosage*
  • Potassium Compounds / adverse effects
  • Prospective Studies
  • Serum Albumin, Human
  • Sulfhydryl Compounds / blood
  • Time Factors
  • Treatment Outcome
  • Troponin I / blood
  • Turkey


  • Advanced Oxidation Protein Products
  • Biomarkers
  • Cardioplegic Solutions
  • Hemoglobins
  • Potassium Compounds
  • Sulfhydryl Compounds
  • Troponin I
  • ischemia-modified albumin
  • potassium cardioplegic solution
  • Creatine Kinase, MB Form
  • N-Acetylneuraminic Acid
  • Serum Albumin, Human