Prospective, randomized trial comparing blood and oxygenated crystalloid cardioplegia in reoperative coronary artery bypass grafting.
OBJECTIVE
Reoperative coronary artery bypass grafting presents unique challenges for myocardial preservation. The purpose of this study was to compare oxygenated blood cardioplegia with oxygenated crystalloid cardioplegia during reoperative coronary artery bypass grafting using transesophageal echocardiography to assess regional wall motion of the left ventricle before and after cardiopulmonary bypass.


METHODS
Sixty-one patients undergoing reoperative coronary artery bypass grafting were prospectively randomized to receive oxygenated blood cardioplegia or oxygenated crystalloid cardioplegia delivered with a combined antegrade-retrograde technique. Transgastric short axis views of the left ventricle were made with transesophageal echocardiography during the operation before cardiopulmonary bypass and immediately after cardiopulmonary bypass. Regional wall motion was graded by a blinded observer, and before cardiopulmonary bypass scores were compared with after cardiopulmonary bypass scores.


RESULTS
No significant differences were found in the change in regional wall motion score from before cardiopulmonary bypass to after cardiopulmonary bypass between the blood and crystalloid cardioplegia groups.


CONCLUSIONS
This study found blood and crystalloid cardioplegia to be equally efficacious for myocardial preservation during reoperative coronary artery bypass grafting.
Shanewise
J S
JS
Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA.
Kosinski
A S
AS
Coto
J A
JA
Jones
E L
EL
D001639:Bicarbonates / Q000008:administration & dosage; D002122:Calcium Chloride / Q000008:administration & dosage; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D001026:Coronary Artery Bypass; D000077324:Crystalloid Solutions; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D007552:Isotonic Solutions; D008274:Magnesium / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000097:blood / Q000503:physiopathology / Q000601:surgery; D010100:Oxygen; D010952:Plasma Substitutes / Q000008:administration & dosage*; D011189:Potassium Chloride / Q000008:administration & dosage; D011446:Prospective Studies; D012086:Reoperation; D012965:Sodium Chloride / Q000008:administration & dosage; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology
D001639:Bicarbonates; D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; C041711:St. Thomas' Hospital cardioplegic solution; D012965:Sodium Chloride; D011189:Potassium Chloride; D008274:Magnesium; D002122:Calcium Chloride; D010100:Oxygen