Blood versus crystalloid cardioplegia for myocardial protection of donor hearts during transplantation: A prospective, randomized clinical trial.
OBJECTIVE
To assess the safety and efficacy of myocardial protection of the donor heart during transplantation with the use of blood cardioplegia, a prospective randomized clinical trial was undertaken between January 1997 and March 1998.


METHODS
Forty-seven consecutive patients were assigned either to crystalloid (27 patients; group 1) or blood cardioplegia (20 patients; group 2). Comparison of recipient age (54 +/- 11 years vs 55 +/- 7 years; P =. 9), sex (89% vs 90% male patients; P =.9), diagnosis (63% vs 65% dilated cardiomyopathy; P =.8), elevated pulmonary vascular resistance (30% vs 30%; P =.9), prior cardiac operations (22% vs 30%; P =.5), need for urgent heart transplantation (7% vs 20%; P =. 2), donor age (32 +/- 11 years vs 31 +/- 13 years; P =.7), cause of death (33% vs 40% vascular; P =.5), and global myocardial ischemia (176 +/- 51 minutes vs 180 +/- 58 minutes; P =.5) showed no difference. Hemodynamically unstable donors (15% vs 45%; P =.02) were more prevalent in group 2.


RESULTS
Operative mortality rates (4% vs 5%; P =.8), high-dose inotropic support (41% vs 30%; P = 0.6), and postoperative mechanical assistance (11% vs 10%; P = 0.9) were comparable in the 2 groups. Prevalence of acute right heart failure (27% vs 0; P =.02) and of temporary complete atrioventricular block (52% vs 20%; P =.02) were greater in group 1. Spontaneous sinus rhythm recovery was more prevalent in group 2 (11% vs 40%; P =.02). Higher peak creatine kinase (1429 +/- 725 u/L vs 868 +/- 466 u/L; P =.01) and creatine kinase MB (144 +/- 90 u/L vs 102 +/- 59 u/L; P =. 06) levels suggested more severe ischemic injury in group I.


CONCLUSIONS
Use of blood cardioplegia was associated with a lower prevalence of right heart failure, cardiac rhythm dysfunction, and laboratory evidence of ischemia.
Luciani
G B
GB
Division of Cardiac Surgery, University of Verona, Verona, Italy. luciani@netbusiness.it
Faggian
G
G
Montalbano
G
G
Casali
G
G
Forni
A
A
Chiominto
B
B
Mazzucco
A
A
D000328:Adult; D001769:Blood; D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D005260:Female; D006085:Graft Survival; D006324:Heart Arrest, Induced / Q000379:methods; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality / Q000502:physiology; D006801:Humans; D007165:Immunosuppression Therapy; D007430:Intraoperative Care; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000453:epidemiology / Q000517:prevention & control*; D010952:Plasma Substitutes; D011446:Prospective Studies
D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes