Blood cardioplegia with warm reperfusion versus intermittent aortic crossclamping in myocardial revascularization. Randomized controlled trial.
To compare the efficiency of two methods of myocardial protection--blood cardioplegia and warm reperfusion with aspartate-glutamate enrichment of the solution versus intermittent aortic crossclamping--we randomized 60 patients for coronary artery bypass grafting. Hemodynamic parameters and hospital mortality were the end points. Pathologic antecedents and preoperative clinical conditions were similar in both group I (blood cardioplegia, 30 patients) and group II (aortic crossclamping, 30 patients). An average of 2.9 grafts per patient were performed in group I and 3.1 in group II. Duration of extracorporeal circulation was 100 +/- 28 minutes in group I and 85 +/- 23 minutes in group II (p < 0.05). The total time of aortic crossclamping was 62.8 +/- 24.5 minutes in group I and 44.3 +/- 14.9 minutes in group II (p < 0.05). There were comparable increases in cardiac index in group I and group II from the preoperative period to the first postoperative day, but none of these changes reached statistical significance. There were two deaths, one in the cardioplegia group (3.3%) and another in the intermittent aortic crossclamping group (3.3%). In conclusion, in myocardial revascularization, intermittent aortic crossclamping and blood cardioplegia with warm reperfusion enriched with aspartate-glutamate solution are methods of similar efficiency.
Gerola
L R
LR
Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, Brazil.
Oliveira
S A
SA
Moreira
L F
LF
Dallan
L A
LA
Delgado
P
P
da Luz
P L
PL
Jatene
A D
AD
D001011:Aorta; D001224:Aspartic Acid; D001769:Blood; D002314:Cardioplegic Solutions; D003250:Constriction; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D005971:Glutamates; D018698:Glutamic Acid; D006324:Heart Arrest, Induced / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods; D011183:Postoperative Complications; D013696:Temperature
D002314:Cardioplegic Solutions; D005971:Glutamates; D007527:Isoenzymes; D001224:Aspartic Acid; D018698:Glutamic Acid; D003402:Creatine Kinase