Are you adding anything to your "hotshot"? If it is only warmed blood, there is little to no difference between simply taking off the clamp compared to running cardioplegia...with the possible exception that you might have higher pressures in a dedicated cardioplegia line, and, if you are giving retrograde, of course that is different. Otherwise, what drugs are added to your hotshot?

Thank you Scott. The terminology "Hotshot" has been deviated from Buckberg concepts and origins... It is only WARM BLOOD no enhanced substrates or potassium. This "hotshot" 400ml is given antegrade (via aortic root) or retrograde (Coronary Sinus 30-40 mmHg@ low plegia line pressures approx. 90mmHg) just prior the x-clamp removal. If you are using Custodiol have you noticed a trend in reduction of VF? Thanks again. Mauricio

Mauricio, OK, then your warm blood infusion prior to taking off the x-clamp is simply a way to shorten or mitigate your ischemic time, or to facilitate de-airing of grafts. For a warm-shot to serve other purposes, you'd have to be sending additives in with the warm blood. Otherwise, you might as well simply take off the clamp: why waste time with a warm infusion of the same warm blood that will perfuse the vessels as soon as the clamp is removed?

I have not been able to observe a significant number of Custodiol cases to compare with variations of the St. Thomas/Buckburg/Other High K+ techniques, so, I cannot comment on incidence of V-fib afterward.

We still have much to learn about cardioplegia. Things that "make sense" may not produce a clinical difference most of the time, but, in certain situations, make a world of difference...specifically referring to how depolarizing techniques may contribute to some variations of reperfusion injury, compared to hyper-polarizing techniques, and each technique may be improved by a certain additive or mixture prior to introducing high-Oxygen content blood back into the ischemic tissues. I've even considered using venous blood to avoid the high-O2 content during reperfusion, but, venous blood still has a high O2 content.

Obviously, I have more questions than firm answers!

All true. Thanks for your time Scott. Keep in touch.

I'll keep watching to see if someone more knowledgeable comes along to answer your questions, Mauricio! Nice to talk with you...

For hotshot;

dose: weight x 6 / delivery time: 3 minutes / temperature: 35-36 degrees centigrade / bicarbonate and magnesium supported

how do you find this application?

Emre, it's a good a guess as any! However, I'm not sure bicarb is called for...that will be shifting the oxy-Hb curve to the left. On the other hand, if the heart has been truly ischemic enough and used up all of it's buffers to reactive oxidative species components, perhaps bicarb is useful. It comes back to: we really don't know much more than "Well, it seems to work for us." I can't count the number of times a surgeon decided to try another cardioplegia technique after his or her "usual dose" had a patient that obviously had a stunned heart. If it were due to inadequate cardioplegic technique, they wouldn't have suddenly discovered that it didn't work....that technique would have been failing for years. As a profession, we just don't seem to have consensus on what is "best" for which subset of patients...although I would be surprised if there were only one "best" that works for all patients.