Background
aortic cross clamping and CPB, myocardial ischemia, reperfusion injury, myocardial injury, cerebral ischemia
MYOCARDIAL INFARCTION, MYOCARDIAL ISCHEMIA, COMPLICATION, CONGESTIVE HEART FAILURE, HEART FAILURE, SEQUELAE, CEREBRAL ISCHEMIA
Perioperative myocardial injury is a common and serious complication in adult patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) [Several factors may contribute to elevation of troponin in patients undergoing cardiac surgery under CPB. Inadequate myocardial protection coupled with surgical manipulations, reperfusion injury and oxygen/supply disbalance promote myocardial ischemia and lead to myocardial injury and increased troponin release. Therefore, adequate myocardial protection is the cornerstone in the management of patients undergoing cardiac surgery under cardiopulmonary bypass.Modulation of substrate utilization and increasing myocardial high-energy phosphate stores seems to be a promising strategy to reduce the sequelae of myocardial injury. The phosphocreatine system plays an important role in the energy metabolism of cardiomyocytes. According to the “shuttle” hypothesis the main goal of this system is to provide transport of high-energy phosphates from the sites of adenosine triphosphate (ATP) production (mitochondrial matrix) to the sites of ATP utilization (myofilaments, sarcoplasmic reticulum, plasma membrane, etc.) [Numerous clinical studies suggested favorable effects of phosphocreatine (PCr) supplementation in different patient populations including congestive heart failure, cardiac surgery, myocardial infarction and cerebral ischemia [As above described, there is extraordinary experimental evidence on the essential role of the PCr system in the energy metabolism of the heart, with altered energetics playing an important role in the mechanisms of heart failure. At the same time there is a plenty of low-quality clinical evidence that accumulated over the years in this field suggesting that PCr and its analogues have cardioprotective qualities that can translate into improved clinically relevant outcomes.We hypothesized that perioperative PCr intravenous administration plus PCr added to the cardioplegic solution in patients with double/triple valve procedures undergoing cardiac surgery with prolonged periods of aortic cross clamping and CPB would improve heart protection in postoperative period. We also aimed to identify the best endpoint for a future adequately powered study.