Minimally-diluted blood cardioplegia supplemented with potassium and magnesium for combination of 'initial, continuous and intermittent bolus' administration.
BACKGROUND
The present study was designed to examine the hypothesis that minimally-diluted blood cardioplegia (BCP) supplemented with potassium and magnesium provides superior myocardial protection in comparison with the standard-diluted BCP for a combination of 'initial, continuous, and intermittent bolus' BCP administration.


RESULTS
Seventy patients undergoing elective coronary revascularization between 1997 and 2001 (M : F =55:15, mean age 67.6+/-7.5 years) were randomly divided into 2 groups: Group C (n=35) was given the standard 4:1-diluted blood-crystalloid BCP, and Group M (n=35) was given minimally-diluted BCP supplemented with potassium-chloride and magnesium-sulfate. The BCP temperature was maintained at 30 degrees C. Cardioplegic arrest was induced with 2 min of initial antegrade BCP infusion, followed by continuous retrograde BCP infusion. Intermittent antegrade BCP was infused every 30 min for 2 min. The time required for achieving cardioplegic arrest was significantly shorter in Group M (47.5+/-16.3 vs 62.5+/-17.6 s, p<0.0001). The number of patients showing spontaneous heart beat recovery after reperfusion was significantly larger in Group M (28 vs 15, p=0.0029), and the number of patients suffering from atrial fibrillation during the postoperative period was significantly smaller in Group M (n=3 vs 11, p=0.034). Both the postoperative maximum dopamine dose (3.57+/-2.46 vs 5.44+/-2.23 microg/kg per min, p=0.0014) and peak creatine kinase-MB (19.5+/-8.5 vs 25.8+/-11.9 IU/L, p=0.0128) were significantly less in Group M. The number of patients showing paradoxical movement of the ventricular septum in the early postoperative echocardiography was significantly smaller in Group M (9 vs 24, p=0.0007).


CONCLUSIONS
These results suggest that 'initial, continuous and intermittent bolus' administration of minimally-diluted BCP supplemented with potassium and magnesium is a reliable and effective technique for intraoperative myocardial protection.
Hayashi
Yoshitaka
Y
Division of Cardiovascular Surgery, Osaka Minami National Hospital, Kawachinagano, Japan.
Ohtani
Masakatsu
M
Sawa
Yoshiki
Y
Hiraishi
Taizo
T
Akedo
Hiroshi
H
Kobayashi
Yasuhiko
Y
Matsuda
Hikaru
H
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology; D001769:Blood; D002314:Cardioplegic Solutions / Q000008:administration & dosage / Q000592:standards / Q000627:therapeutic use*; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D004298:Dopamine / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004452:Echocardiography; D005260:Female; D006324:Heart Arrest, Induced; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care; D007527:Isoenzymes / Q000097:blood; D008274:Magnesium / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D009204:Myocardial Revascularization / Q000009:adverse effects; D009994:Osmolar Concentration; D011184:Postoperative Period; D011188:Potassium / Q000008:administration & dosage*; D017680:Potassium Compounds; D020127:Recovery of Function; D015203:Reproducibility of Results; D013696:Temperature; D013997:Time Factors; D016896:Treatment Outcome
D002314:Cardioplegic Solutions; D004338:Drug Combinations; D007527:Isoenzymes; D017680:Potassium Compounds; C018369:potassium cardioplegic solution; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D008274:Magnesium; D011188:Potassium; D004298:Dopamine