Systemic hyperkalemia and mild hypothermia for valve surgery in patients with patent internal mammary artery graft.
Myocardial protection is compromised in patients with a patent internal mammary artery (IMA) graft. We assessed the advantages of systemic hyperkalemia with mild hypothermia for valve surgery in patients with a patent IMA graft. Nine patients (mean age 71.5+/-7.0 years) with a patent IMA graft underwent valve surgery from May 2004 to July 2009. Of those, eight underwent aortic valve replacement and one mitral repair, with two double-valve surgery. Antegrade and retrograde blood cardioplegia were performed intermittently, and systemic potassium was given to all. The lowest bladder temperature was 27.2+/-2.4 degrees C, and the initial and peak systemic potassium levels were 6.8+/-1.4 and 8.0+/-1.6 mEq/l, respectively, while potassium at the end of the cardiopulmonary bypass procedure after sufficient modified ultrafiltration was reduced to 5.5+/-0.6 mEq/l. There was one hospital death due to ischemic colitis. Cardiac arrest was easily achieved in each patient without IMA or aortocoronary graft injury. The postoperative peak creatine kinase-MB level was 33+/-17 IU/l, with no ST changes seen in electrocardiogram findings or new asynergy seen in echocardiogram findings. Systemic hyperkalemia and mild hypothermia for valve surgery in patients with a patent IMA graft is a good option to reduce graft and myocardial injuries.
Fujita
Tomoyuki
T
Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita City, Osaka 565-8565, Japan. tomofujita@nifty.com
Kobayashi
Junjiro
J
Nakajima
Hiroyuki
H
Toda
Koichi
K
D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced* / Q000401:mortality; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000401:mortality; D008323:Mammary Arteries / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D011189:Potassium Chloride / Q000008:administration & dosage*; D017680:Potassium Compounds / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
D017680:Potassium Compounds; C018369:potassium cardioplegic solution; D011189:Potassium Chloride