Early changes in regional and global left ventricular function after aortic valve replacement. Comparison of crystalloid, cold blood, and warm blood cardioplegias.
BACKGROUND
The clinical effects of different cardioplegic methods on left ventricular (LV) function have not been fully elucidated, particularly in the setting of myocardial hypertrophy.


RESULTS
Sixty-four patients (mean age, 62 +/- 12 years; 41 men, 23 women) who were undergoing elective aortic valve replacement (stenosis, 49; regurgitation, 15; concomitant coronary artery bypass grafting, 22), with LV mass index 230 +/- 70 g/m2, were randomized to the following groups: antegrade crystalloid cardioplegia (CCP, 21 patients), antegrade/retrograde cold blood cardioplegia (CBP, 23 patients), or continuous retrograde warm (37 degrees C) blood cardioplegia (WBP, 20 patients). Mean aortic cross-clamp and cardiopulmonary bypass times were 100 +/- 20 and 126 +/- 24 minutes. Positive inotropic drug therapy was required postoperatively in 9 patients after CBP, 14 after CCP, and 18 after WBP. Perioperative LV function was assessed using transesophageal M-mode echocardiography, combined with high-fidelity LV pressure recording and thermodilution cardiac output, before bypass and 0.5, 1, 3, 6, 12, and 20 hours after cross-clamp removal. There was a similar fall in LV peak circumferential wall stress at constant LV end-diastolic dimension in each group after aortic valve replacement. The increase in contraction velocity was significant from 0.5 hour with CBP; however, no significant increase occurred until 12 hours with CCP and until 20 hours with WBP. The rate and extent of LV pressure fall and early diastolic filling rate both increased with CBP, and only in this group did ventricular coordination improve. LV stroke work index was maintained with CBP throughout the postoperative period with less inotropic support than with the other two methods.


CONCLUSIONS
In the hypertrophied LV, CBP offers the best preservation of myocardial physiological response and ventricular function with less inotropic support.
Jin
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XY
Academic Department of Cardiothoracic Surgery, National Heart and Lung Institute, London, UK.
Gibson
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DG
Pepper
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JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D002314:Cardioplegic Solutions; D003080:Cold Temperature; D000077324:Crystalloid Solutions; D017548:Echocardiography, Transesophageal; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006358:Hot Temperature; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes; D011184:Postoperative Period; D016277:Ventricular Function, Left
D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes