Abstract :
In summary, in the context of warm or tepid blood cardioplegia, the mini-cardioplegia concept has reasonably well-documented advantages over the standard 4:1 dilution ratio, which are of four types: (1) improved oxygen supply because of the combination of a rightward shift of the oxyhemoglobin dissociation curve and a greater number of available red blood cells, (2) improved control of blood volume because of the limitation of fluid overload (which greatly contributes to early postoperative extubation), (3) improved practicality because a simple electrically driven pump can substitute for more complex blood/ crystalloid mixing devices, and (4) improved cost-effectiveness because the expenses related to these delivery systems, various biochemical additives, and, eventually, fluidremoving devices like ultrafilters or cell-saving devices are eliminated. Thus, in a period where a positive feature of economic constraints is to force us to reassess our practice patterns, the use of minimally hemodiluted hyperkalemic blood appears as a sound approach for increasing the simplicity and low cost of cardioplegia delivery without compromising the quality of the protection that it currently provides. Furthermore, this concept of concentrated cardioplegia does not exclude the future inclusion, in a still-limited volume of crystalloid vehicle, of additives that would be of clinical benefit, among which agents favorably interfering with neutrophilendothelial cell interactions appear particularly appealing [36].
