title: Effect of induction and reperfusion with warm substrate-enriched cardioplegia on ventricular function.
abstract: BACKGROUND
  This study tested the hypothesis that induction and reperfusion with warm substrate-enriched (IRWSE) blood cardioplegia improves postoperative left ventricular (LV) function in patients undergoing elective coronary bypass surgery (CABG).
  
  
  METHODS
  After giving informed consent, 67 patients scheduled for CABG surgery were randomized to either IRWSE + cold blood (CB) or CB alone. IRWSE cardioplegia consisted of 37 degrees C substrate-enriched (glutamate, aspartate, hyperkalemic) anterograde and retrograde blood cardioplegic solution followed by non-substrate-enriched cardioplegic solution given at 4 degrees C to 8 degrees C. LV function was measured with ventriculograms, volume conductance catheters, echocardiography, and multiple gated (image) acquisition.
  
  
  RESULTS
  The end-systolic pressure-volume relationship was improved postbypass in the IRWSE + CB group (CB, 1.5 +/- 0.74 mm Hg/mL vs IRWSE + CB, 2.1 +/- 1.2 mm Hg/mL; p = 0.042). The postoperative ejection fraction (EF%) was better preserved in the CB group (CB, 65 +/- 11.53% vs IRWSE + CB, 58.62 +/- 11.75%; p < 0.04).
  
  
  CONCLUSIONS
  Our results demonstrate a transient improvement in LV systolic function in the immediate postbypass period in CABG patients in the IRWSE + CB group. The intraoperative benefits of the IRWSE + CB technique did not persist in the postoperative period.
authors.affiliation: Department of Surgery, University of California, San Francisco Veterans Affairs Medical Center, USA. awallace@cardiacengineering.com
authors.forename: A W
authors.initials: AW
authors.lastname: Wallace
authors.forename: M B
authors.initials: MB
authors.lastname: Ratcliffe
authors.forename: P S
authors.initials: PS
authors.lastname: Nosé
authors.forename: W
authors.initials: W
authors.lastname: Bellows
authors.forename: W
authors.initials: W
authors.lastname: Moores
authors.forename: M T
authors.initials: MT
authors.lastname: McEnany
authors.forename: K
authors.initials: K
authors.lastname: Flachsbart
authors.forename: D T
authors.initials: DT
authors.lastname: Mangano
mesh_terms: D000328:Adult; D000368:Aged; D001769:Blood; D002314:Cardioplegic Solutions; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology; D016037:Single-Blind Method; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D013696:Temperature; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D002314:Cardioplegic Solutions