Warm blood cardioplegia.
Between 1990 and 1992, 346 consecutive patients underwent coronary artery bypass procedures. Ninety-eight patients (group A) from 1990 served as historical controls, and 248 patients (group B) from 1991 to 1992 served as a prospective, consecutive cohort for statistical comparison. The two groups varied in the type of myocardial protection used: intermittent cold crystalloid cardioplegia was used in group A and continuous warm blood cardioplegia in group B. (Two patients in group A received intermittent cold blood cardioplegia, and these 2 patients are grouped with the crystalloid group for the sake of convenience. The presence or absence of these 2 patients did not alter the group A statistics in any noticeable manner). Class IV high-risk groups demonstrated a 63% reduction in mortality (p = 0.07), and overall group B experienced a 28% reduction in mortality (4.4% versus 6.1%; p = not significant), an 86% reduction in perioperative myocardial infarction rate (1.6% versus 12.2%; p < 0.05), a 20% reduction in postoperative bleeding (275 versus 345 mL.day-1.m-2), and a marked reduction in reentry rates (p = 0.05). Also noted was a 32% reduction in postoperative ventilation requirements (25 versus 37 hours; p = 0.05). Less inotrope was required and intraoperative stroke was not seen in the patients with warm blood cardioplegia. Group B patients were less likely to have development of complex postoperative arrhythmias. Ventricular fibrillation at unclamping was noticeably rare (2.0% in group B versus 84% in group A; p < 0.05). The average group B heart resumed sinus rhythm 72 seconds after declamping.(ABSTRACT TRUNCATED AT 250 WORDS)
Vaughn
C C
CC
Phoenix Baptist Hospital, Phoenix, Arizona.
Opie
J C
JC
Florendo
F T
FT
Lowell
P A
PA
Austin
J
J
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001769:Blood; D016063:Blood Loss, Surgical; D002303:Cardiac Output, Low / Q000209:etiology; D002314:Cardioplegic Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D003080:Cold Temperature; D001026:Coronary Artery Bypass; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D006358:Hot Temperature; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D013997:Time Factors; D016277:Ventricular Function, Left
D002314:Cardioplegic Solutions