title: Myocardial protection in operations requiring more than 2 h of aortic cross-clamping.
abstract: OBJECTIVE
  Long periods of aortic cross-clamping time during cardiac surgery are associated with high rates of morbidity and mortality because of damage to the myocardium. Recently, we have used a method of myocardial protection based on the principles of hyperkalemic cardioplegic arrest. We use antegrade administration of warm, undiluted blood followed by continuous retrograde infusion of tepid, undiluted blood supplemented with potassium and magnesium. In this study, we have retrospectively reviewed our experience with this method of cardioprotection in operations requiring more than 2 h of cross-clamp time.
  
  
  METHODS
  We retrospectively reviewed the medical records of 1280 patients who underwent myocardial revascularization, valve repair or replacement, or a combination of both operations between January 1, 1994 and December 31, 1997. Patients were divided into two groups: the short cross-clamp group (SXC) (n = 1144) had cross-clamp times < 120 min (mean, 78 +/- 20 min; range, 35-119 min) and the long cross-clamp group (LXC) (n = 136) had cross-clamp times > 120 min (mean, 154 +/- 31 min; range, 120-277 min). We compared preoperative, operative, and postoperative variables between the two groups.
  
  
  RESULTS
  Significantly more patients in the long cross-clamp group (43.4%) underwent the combined operation than in the short cross-clamp group (2.3%), and the rate of reoperation was significantly higher in the long cross-clamp group (12%) than in the short cross-clamp group (5%). Despite these differences in operative complexity, we found no difference in hospital mortality rates between the two groups. The only significant postoperative differences were that the long cross-clamp group had a greater need for inotropic agents (43 vs. 29%), higher serum levels of creatine kinase (880 +/- 583 vs. 613 +/- 418) and CK-MB (10.9 +/- 6.4 vs. 5.9 +/- 5.2), and a longer hospital stay (9.6 vs. 6.1 days).
  
  
  CONCLUSIONS
  Long, complex operations requiring more than 2 h of cross-clamping can be performed safely with our method of cardioprotection based on continuous retrograde infusion of tepid, hyperkalemic, undiluted blood.
authors.affiliation: Department of Cardiac Surgery, Rambam Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa. y_bar_el@rambam.health.gov.il
authors.forename: Y
authors.initials: Y
authors.lastname: Bar-El
authors.forename: Z
authors.initials: Z
authors.lastname: Adler
authors.forename: A
authors.initials: A
authors.lastname: Kophit
authors.forename: V
authors.initials: V
authors.lastname: Kertzman
authors.forename: S
authors.initials: S
authors.lastname: Sawaed
authors.forename: A
authors.initials: A
authors.lastname: Ross
authors.forename: O
authors.initials: O
authors.lastname: Cohen
authors.forename: S
authors.initials: S
authors.lastname: Milo
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D012189:Retrospective Studies; D013997:Time Factors