Cold crystalloid versus warm blood cardioplegia for coronary artery bypass surgery.
OBJECTIVE
Intermittent cold crystalloid cardioplegia by antegrade route to arrest the heart for coronary artery bypass grafting (CABG) is a commonly used technique. The aim of this study is to compare the intermittent antegrade warm blood cardioplegia with cold crystalloid cardioplegia by means of measuring myocardial injury markers CKMB and troponin T. We also compared the results with antegrade and retrograde warm blood cardioplegia.


METHODS
Patients (n=30) undergoing CABG were prospectively randomized into group 1 (n=10) which received cold crystalloid cardioplegia by antegrade route, group 2 (n=10) which received warm blood cardioplegia by antegrade route and group 3 (n=10) which received antegrade/retrograde warm blood cardioplegia.


RESULTS
Preoperative and intraoperative variables were equal in all three groups. Control levels of troponin T and CKMB were in a normal range. Postoperative troponin T was significantly lower in group 3 compared to group 2 (p"=0.008") and to group 1 (p"=0.005"). CKMB is significantly higher in group 1 compared to group 2 (p"=0.013") and higher in group 2 than that in group 3 (p"=0.043").


CONCLUSIONS
Antegrade with retrograde warm blood cardioplegia is a simple delivery method. Troponin T and CKMB levels were significantly lower, suggesting that this offered better myocardial protection than antegrade cold crystalloid and warm blood cardioplegia. We recommend its wider use.
Dar
Mudassir Iqbal
MI
Department of Cardiothoracic Surgery, Liaquat National Hospital, Karachi, Pakistan.
D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass; D052279:Creatine Kinase, MB Form / Q000097:blood; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D020107:Troponin T; D052279:Creatine Kinase, MB Form