Clinical effect of Bretschneider-HTK and St. Thomas cardioplegia on hemodynamic performance after bypass measured using an automatic datalogging database system.
A prospective consecutive study was undertaken to compare the hemodynamic effect of two cardioplegic solutions in CABG patients after bypass, and in relation to aorta occlusion time with the support of a automatic datalogging database. A total of 249 patients were randomized. One group received Bretschneider cardioplegic HTK solution (132 patients, group I) the other group received St. Thomas cardioplegic solution (117 patients, group II). The data was divided in four periods of aortic clamp time: less than or equal to 40 min (group I 26 patients, group II 32 patients); 41-60 min (group I 49 patients, group II 47 patients); 61-80 min (group I 30 patients, group II 29 patients); and greater than 80 minutes (group I 27 pts, group II 9 patients). Anesthesia regime and therapeutic drugs and infusions were given in both groups in similar dosages. Within both groups HR, CO, PAP, PCWP increased after bypass in relation to prebypass values. SVR decreased in both groups by 30%, MAP and PVR decreased only in group I. Between group I and II differences were found in the CI (3.0 vs. 3.3 l/min/m2), MAP (70 vs. 76 mmHg), PMAR (18 vs. 16 mHg), and SVR (827 vs. 954 dyn.sec.cm-5). In significantly more of the patients in group I, sinus rhythm started spontaneously after the release of the aorta clamp (39.5% vs. 20.4%, p less than 0.005). Patients in group I needed temporarily a pacemaker after bypass in 6.3% cases (in 1.1% of patients in group II,). There was no relation of the hemodynamic data in relation to aorta occlusion time within the groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Gallandat Huet
R C
RC
Dept. of Anesthesia, University Hospital Groningen, Netherlands.
Karliczek
G F
GF
van der Heide
J N
JN
Brenken
U
U
Mooi
B
B
van der Broeke
J J
JJ
Jenkins
I
I
de Geus
A F
AF
D001639:Bicarbonates / Q000008:administration & dosage; D002122:Calcium Chloride / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D003201:Computers; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D005947:Glucose / Q000008:administration & dosage; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008274:Magnesium / Q000008:administration & dosage; D008353:Mannitol / Q000008:administration & dosage; D011189:Potassium Chloride / Q000008:administration & dosage; D011343:Procaine / Q000008:administration & dosage; D011897:Random Allocation; D012815:Signal Processing, Computer-Assisted; D012965:Sodium Chloride / Q000008:administration & dosage
D001639:Bicarbonates; C039984:Bretschneider cardioplegic solution; C041711:St. Thomas' Hospital cardioplegic solution; D008353:Mannitol; D012965:Sodium Chloride; D011343:Procaine; D011189:Potassium Chloride; D008274:Magnesium; D005947:Glucose; D002122:Calcium Chloride