Improved myocardial preservation by improved distribution of cardioplegic solutions.
Two groups of elective coronary artery bypass graft (CABG) patients were compared with respect to a single variable: method of cardioplegia administration. All patients had saphenous vein grafts and all distal anastomoses were done with continuous aortic occlusion and intermittent administration of a 4 degrees C cardioplegic solution. One hundred patients in Group I had the distal anastomoses performed before the proximal anastomoses with cardioplegic solution administered only via the aortic root. One hundred patients in Group II had the proximal anastomoses performed first so that cardioplegic solution also perfused beyond coronary obstructions as each subsequent distal anastomosis was completed. Aortic occlusion averaged 6 minutes longer in Group II (46.5 minutes) than in Group I (40.3 minutes) (p less than 0.01). Mortality from cardiac causes was six times greater in Group I than in Group II (6% versus 1% p = 0.027) and overall mortality was eight times greater in Group I than in Group II (8% versus 1%; p = 0.008). We conclude that earlier cardioplegic perfusion of myocardium beyond obstructed coronary arteries substantially improves myocardial protection.
D000418:Albumins / Q000008:administration & dosage; D002315:Cardiopulmonary Bypass; D005947:Glucose / Q000008:administration & dosage; D006324:Heart Arrest, Induced; D006801:Humans; D011189:Potassium Chloride / Q000008:administration & dosage; D012965:Sodium Chloride / Q000008:administration & dosage; D012996:Solutions
D000418:Albumins; D012996:Solutions; D012965:Sodium Chloride; D011189:Potassium Chloride; D005947:Glucose