Intermittent antegrade cardioplegia: warm blood vs cold crystalloid. A clinical study.
Intermittent antegrade warm blood cardioplegia (IAWBC) is a not usual technique of myocardial protection. We propose a delivery protocol that standardizes the length of ischemic intervals, duration of each cardioplegic dose and K+ amount. Cardioplegia is represented by blood, taken from the oxygenator and injected directly into the aortic root, and K+, added by means of a syringe pump. We reviewed the first 300 patients who underwent elective or urgent coronary artery by-pass procedures (group A) and compared them with the last 300 patients operated on with intermittent antegrade cold crystalloid cardioplegia (group B). The overall mortality in group A was lower than in group B (0.7 vs 3.0, p < 0.05); there was no in-hospital death in patients with poor left ventricle (LVEF < 35%) in group A (0/64 vs 3/39, p < 0.025). Reduction of mortality was due to a drastic fall of morbidity. In group A no patients needed circulatory assistance (13 in group B, p < 0.0005) or intraaortic balloon pumping (9 in group B, p < 0.005) in operating room or in intensive care unit (ICU); only 1 patient had inotropic drug (29 in group B, p < 0.0005) and only 6 needed lignocaine infusion (27 in group B, p < 0.0005). Incidence of postoperative myocardial infarction was lower in group A (4 vs 9 in group B) as well cerebrovascular accidents (4 vs 10 in group B), but difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
Calafiore
A M
AM
Istituto di Clinica Cardiovascolare, Università di Chieti, Italy.
Teodori
G
G
Di Giammarco
G
G
Bosco
G
G
Mezzetti
A
A
Lapenna
D
D
Verna
A M
AM
D000368:Aged; D001769:Blood; D002314:Cardioplegic Solutions; D003080:Cold Temperature; D001026:Coronary Artery Bypass / Q000401:mortality; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods* / Q000401:mortality; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013696:Temperature
D002314:Cardioplegic Solutions; D007527:Isoenzymes; D003402:Creatine Kinase