Effectiveness and Efficiency of Mistral Cardioplegia Heat Exchanger for Myocardial Solutions in Cardiac Surgery

Abstract

Abstract Background The heat exchangers are composed of two pathways, one for the perfusate (blood or cardioplegia mixture) and one for water. These pathways are separated by material that allows efficient thermal exchange between the fluids. The role of the heat exchanger for the temperature transfer on cardioplegic solution through the delivery system is fundamental for metabolic myocardial preservation and protection in cardiac surgery procedures. The system allows for a user defined, variable concentration of warm, tepid or cold solution to be delivered. In this context we present a retrospective analysis on Mistral Cardioplegia Heat Exchanger and delivery system disposable (Eurosets, Srl, Medolla, Italy) in terms of effectiveness and efficiency during myocardial protection techniques. Materials and Methods In this retrospective study we collected 100 cardiac surgery procedures involved the use of Mistral Cardioplegia Heat Exchanger and disposables delivery systems for cardioplegic solutions. Fifty patients used the Mistral Cardioplegia Heat Exchanger, for Blood cardioplegic solution, managed with the temperature of 28 (°C), twenty-five used closed delivery system and twenty-five with soft shell reservoir delivery system; Fifty patients used the Mistral Heat Exchanger, for Crystalloid cardioplegic solution managed with the temperature of 4 (°C), twenty-five were used closed delivery system and twenty-five with soft shell reservoir delivery system. We evaluated the performance in terms of thermal exchange, between the set value and the expected temperature value during the myocardial solution administration in relation to the flow, hematocrit and pressure in the various delivery systems for the blood and crystalloid solution and in terms safety relative at the incidence of adverse event. Results The patients with St. Thomas blood cardioplegia solution at 28 °C (set value) Vs the patients with crystalloid Custodiol HTC ® solution at 4 °C (set value) reported a mean value for the cardiopulmonary bypass time of: 93 ± 12 Vs 140 ± 17 (min.); the cross-clamp time was: 65 ± 8 Vs 109 ± 15 (min.); the expected temperature value (°C) during blood cardioplegia for closed blood delivery system Vs soft shell reservoir delivery system was: 28 ± 0.91 Vs 28 ± 0.1, p-value = 0.91; the expected temperature value (°C)during crystalloid Custodiol HTC ® solution for closed delivery system Vs soft shell reservoir delivery system was: 4 ± 0.97 Vs 4 ± 0.13, p-value = 0.97. No adverse event was reported in both groups and subgroups. Conclusions The results of this study suggested that the Mistral Cardioplegia Heat Exchanger and delivery systems disposable for cardioplegia (Eurosets, Srl, Medolla, Italy) were effectiveness and efficiency in the management of myocardial protection techniques in terms of temperature and delivery. The systems used were safety and not reported adverse event during the procedures.