Effect of cold blood cardioplegia enriched with potassium-magnesium aspartate during coronary artery bypass grafting.
OBJECTIVE
The aim of this investigation is to evaluate the effect of enriched with potassium-magnesium aspartate cold-blood cardioplegia on early reperfusion injury and postoperative arrhythmias in patients with ischemic heart disease undergoing coronary artery bypass grafting (CABG), using measurements of cardiac troponin I (CTnI), hemodynamic indexes and clinical parameters.


METHODS
Forty patients with three-vessel coronary artery disease (CAD) and stable angina, receiving first-time elective CABG, were randomly divided into 2 groups: patients in control group (C group n=20) received routine institutional cold blood cardioplegia (4 degrees C) concentration of Mg2+4 mmol/L, Ca2+1.2 mmol/L and K+ 24mmol/L during myocardial arrest. Patients in P group (n=20) received modified cold blood cardioplegia enriched with potassium-magnesium aspartate and maintained concentration of Mg2+10 mmol/L, Ca2+1.2 mmol/L and K+20mmol/L in the final blood cardioplegia solution. Clinical outcomes were observed during operation and postoperatively. Serial venous blood samples for CTnI were obtained before induction, after cardiopulmonary bypass (CPB), and postoperative 6, 24, and 72 hours. Hemodynamic indexes were obtained before and after bypass by the radial catheter and Swan-Ganz catheter.


RESULTS
In both groups, there were no differences regarding preoperative parameters. There were no cardiac related deaths in either group. The time required to achieve cardioplegic arrest after cardioplegia administration was significantly shorter in P group (47.5+/-16.3 s) than in C group (62.5+/-17.6 s) (P<0.01). The number of patients showing a return to spontaneous rhythm after clamp off was significantly greater in P group (n=20, 100%) than in C group (n=14, 70%) (P<0.01). Eight patients in C group had atrial fibrillation (AF) compared with two patients in P group (P<0.05) in the early of postoperative period. The level of CTnI increased 6 hours and 12 hours postoperatively, and there was a significant difference between groups (P<0.05). P group also shortened the time of postoperative mechanical ventilation (P<0.05) after surgery.


CONCLUSIONS
Cold blood cardioplegia enriched with potassium-magnesium aspartate is beneficial on reducing reperfusion injury.
Ji
B
B
Department of Cardiopulmonary Bypass, Cardiovascular Institute and Fuwai Hospital, Beijing, China. bingyangji@psu.edu
Liu
J
J
Liu
M
M
Feng
Z
Z
Wang
G
G
Lu
F
F
Long
C
C
D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D001026:Coronary Artery Bypass; D004562:Electrocardiography; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery*; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011184:Postoperative Period; D011195:Potassium Magnesium Aspartate / Q000627:therapeutic use*; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D012121:Respiration, Artificial; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D002314:Cardioplegic Solutions; D019210:Troponin I; D011195:Potassium Magnesium Aspartate