Intermittent antegrade warm myocardial protection compared to intermittent cold blood cardioplegia in elective coronary surgery--do we have to change?
OBJECTIVE
Intermittent antegrade warm blood cardioplegia (IAWBC) is a simple and cost-effective method of myocardial preservation. However, there are only few prospective trials comparing this type of cardioplegia to established cardioplegic strategies in elective on-pump coronary surgery with respect to myocardial protection and outcome.


METHODS
In a prospective, randomized trial IAWBC (33 degrees C) (n=100) was compared to intermittent antegrade cold (4 degrees C) blood cardioplegia (n=100), regarding clinical outcome and myocardial protection using cardiac troponin-I (cTNI) and creatine kinase MB isoenzyme (CK-MB) measurements to assess ischemia.


RESULTS
Preoperative parameters were comparable in both groups. Results demonstrated no differences in-between the groups regarding mortality (2.0% both), incidence of perioperative myocardial infarction (2 versus 3%), need for intra-aortic balloon pump (3 versus 4%), length of ICU stay (2.0+/-2.5 versus 2.1+/-3.0 days) and incidence of postoperative atrial fibrillation (41 versus 34%). However, the necessity of defibrillation after cardiac arrest (18 versus 43%, P<0.001) was significantly less frequent and of lower intensity (3.4+/-10.8 versus 10.8+/-20.6 J, P<0.001) in the IAWBC-group. Postoperatively the ischemia markers were significantly lower in the IAWBC-group, cTNI within the first 72 h (from P<0.001 to P=0.013) and even CK-MB within the first 24 h (from P=0.004 to P<0.011).


CONCLUSIONS
IAWBC is a safe and simple method in elective on-pump coronary artery bypass surgery. Significantly lower ischemic markers suggest an improved myocardial protection compared to cold blood cardioplegia in these patients.
Franke
Ulrich F W
UF
Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller-University, Bachstrasse 18, Postfach, D-07740 Jena, Germany. ulrich.franke@med.uni-jena.de
Korsch
Simone
S
Wittwer
Thorsten
T
Albes
Johannes M
JM
Wippermann
Jens
J
Kaluza
Mirko
M
Rahmanian
Parwis B
PB
Wahlers
Thorsten
T
D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000032:analysis; D003080:Cold Temperature; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000378:metabolism; D052279:Creatine Kinase, MB Form; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D007527:Isoenzymes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013696:Temperature; D016896:Treatment Outcome; D020107:Troponin T / Q000378:metabolism
D015415:Biomarkers; D007527:Isoenzymes; D020107:Troponin T; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form