Myocardial function in early hours after coronary artery bypass grafting in patients with left ventricular dysfunction: comparison of blood and crystalloid cardioplegia.
OBJECTIVE
This study was done to evaluate a myocardial function in the early hours after coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction and to compare blood and crystalloid cardioplegia.


METHODS
One hundred consecutive patients with left ventricular ejection fraction <35% scheduled for CABG were randomly divided into 2 groups. In the 1st group we used cold blood cardioplegia, in the 2nd group cold crystalloid cardioplegia. We measured hemodynamic data in the early hours after operation, enzyme release and we collected relevant clinical data.


RESULTS
The mortality rate in the crystalloid and blood cardioplegia group was 2% and 0%, respectively. We didn't find any significant difference in the incidence of perioperative myocardial infarction, arrhythmia and use of intraaortic balloon pumping between groups. Differences between groups were found in the enzymatic response. Average creatine kinase and MB isoenzyme of creatine kinase (CK-MB), was lower in the blood cardioplegia group lower during the whole examined period. We also found some significant differences in hemodynamic data in the postoperative period. In the crystalloid cardioplegia group there was a decrease in left ventricular stroke work index immediately after operation. The preoperative value was reached in about 2 hours after operation. On the other hand, we didn't find this decrease in the blood cardioplegia group. This difference between groups was statistically significant. Other hemodynamic data didn't show any significant difference.


CONCLUSIONS
Blood cardioplegia shows earlier improvement of myocardial function after the operation. It could be beneficial in patients with severe left ventricular dysfunction.
Brat
R
R
Department of Cardiac Surgery, University Hospital, Ostrava, Czech Republic. Radim.Brat@fnspo.cz
Tosovsky
J
J
Januska
J
J
D000368:Aged; D001769:Blood; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D003402:Creatine Kinase / Q000032:analysis; D000077324:Crystalloid Solutions; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced / Q000379:methods*; D006334:Heart Function Tests; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D010952:Plasma Substitutes; D011184:Postoperative Period; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis* / Q000401:mortality
D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D003402:Creatine Kinase