Comparison of simultaneous antegrade/vein graft cardioplegia with antegrade cardioplegia for myocardial protection.
Antegrade cardioplegic delivery via the aorta ensures distribution of cardioplegic solution through open arteries, but distribution may not be adequate beyond a stenotic coronary artery. This potential problem can be overcome by direct delivery of cardioplegia via a vein graft. The purpose of this study was to compare simultaneous antegrade/vein graft cardioplegia with antegrade cardioplegia during coronary artery bypass surgery. Twenty patients were divided into 2 groups. In group 1, intermittent antegrade cardioplegia was provided (n=10). In group 2, intermittent antegrade cardioplegia was supplemented by antegrade perfusion of vein grafts after distal anastomoses were completed (n=10). Data on enzyme release and hemodynamics were obtained preoperatively, before the induction of anesthesia, just before cross-clamping, immediately after aortic unclamping, and at 1, 6, 12, 24, and 48 h after unclamping. Enzyme release (creatinine phosphokinase-isoenzyme MB, cardiac troponin I, myoglobin) was similar in both groups (P>.05). Furthermore, no significant difference was noted in the incidence of postoperative low cardiac output syndrome, perioperative myocardial infarction, or ventricular arrhythmia (P>.05). In conclusion, both techniques permitted rapid postoperative recovery of myocardial function. Supplementation of antegrade perfusion of vein grafts with antegrade cold blood cardioplegia offered no advantage to study patients.However, hemostasis of a distal anastomosis may be controlled by this technique.
Onem
Gokhan
G
Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey.
Sacar
Mustafa
M
Baltalarli
Ahmet
A
Ozcan
Ali Vefa
AV
Gurses
Ercan
E
Sungurtekin
Hulya
H
D015415:Biomarkers; D002037:Bundle-Branch Block / Q000517:prevention & control*; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000517:prevention & control*; D011446:Prospective Studies
D015415:Biomarkers; D002314:Cardioplegic Solutions