Cold blood versus cold crystalloid cardioplegia: a prospective randomised study of 345 aortic valve patients.
OBJECTIVE
Although experimental studies have indicated that blood cardioplegia may be superior to crystalloid cardioplegia for myocardial protection, clinical data still remain uncertain. In a previous randomised study from our institution, including 1440 patients undergoing coronary artery bypass grafting (CABG), no beneficial effects of blood cardioplegia were seen in any relevant outcome variables. The investigation was therefore extended to a patient population having longer pump times and ischaemic periods.


METHODS
Over a 48-month period, all patients undergoing aortic valve replacement with or without CABG performed by two surgeons, were prospectively randomised to receive either intermittent cold retrograde blood cardioplegia (group B) or intermittent cold retrograde crystalloid cardioplegia (group C) during aortic cross-clamping.


RESULTS
A total of 345 patients aged 28-90 years (median, 72 years) entered the study (group B, n=172, group C, n=173). All relevant demographic and operative variables were similar for both groups. As for the clinical course, no statistically significant differences were seen concerning spontaneous sinus rhythm after aortic declamping, use of inotropic drugs, duration of ventilatory support, bleeding and rate of allogeneic blood transfusions, perioperative myocardial infarction, episodes of atrial fibrillation, stroke or minor neurological dysfunction, renal function, infections, physical rehabilitation or mortality. Further, in the patients with the longest ischaemic times, no statistically significant differences between the groups could be demonstrated.


CONCLUSIONS
There were no indications that retrograde cold blood cardioplegia was superior to retrograde cold crystalloid cardioplegia patients undergoing aortic valve replacement, with or without CABG.
Øvrum
Eivind
E
Oslo Heart Center, Division of Cardiovascular and Respiratory Medicine and Surgery, Oslo University Hospital, Rikshospitalet, Box 2684, St. Hanshaugen, 0131 Oslo, Norway. eivind.ovrum@hjertesenteret.no
Tangen
Geir
G
Tølløfsrud
Stein
S
Øystese
Rolf
R
Ringdal
Mari-Anne L
MA
Istad
Reidar
R
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001769:Blood; D002314:Cardioplegic Solutions; D001026:Coronary Artery Bypass / Q000379:methods; D000077324:Crystalloid Solutions; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D007430:Intraoperative Care / Q000379:methods; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions