Cross-clamp fibrillation
Cross-clamp fibrillation (XCF) involves cross-clamping the aorta and
inducing ventricular fibrillation, to allow the heart to continue to
beat during vessel occlusion. A 2019 comparative study on XCF and
cardioplegia in patients undergoing CABG, reviewed 3,340 XCF patients to
measure survival outcomes and post-operative
complications(38). Their results showed that when
compared to cardioplegia, XCF reduced cases of atrial arrhythmias,
post-operative inotropic use and conferred a mean survival
advantage(38). However, there was no reported
difference in mortality between the two
procedures(38).
Glucose-insulin-potassium cardioplegia
The use of a glucose-insulin-potassium (GIK) infusion was first
detailed in 1962 by Sodi-Pallares et al. where it was used to treat
acute myocardial infarction(39). Its mechanism of
cardioprotection has been extensively reviewed and studies indicate that
insulin plays the key role by targeting the the reperfusion injury
salvage (RISK) pathway, which plays a role in reducing
IRI(40). In 2002, the Insulin Cardioplegia Trial
failed to demonstrate a significant difference in post-operative
outcomes between patients receiving insulin solutions versus those in
the placebo group in CABG surgery(41). However,
since then a randomised-control trial by Ellenberger et al. in 2018
researched GIK effects on patients undergoing on-pump heart surgery.
They reported that GIK was associated with better left systolic
ventricular function after weaning off bypass, reduced cardiovascular
and respiratory complications, and shorter ICU stays compared with
saline(42).