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[Is left ventricular regional wall motion after CABG influenced by cardioplegic protection?]
B Shirasawa1, K Hamano, N Ikeda
1First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan.
Insights
Cold crystalloid cardioplegia increased left ventricular wall motion deterioration after coronary artery bypass grafting (CABG). Tepid blood cardioplegia demonstrated better protection, especially for patients with poor collateral arteries.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Myocardial Protection
Context:
- Coronary artery bypass grafting (CABG) requires effective myocardial protection.
- Different cardioplegia techniques aim to preserve left ventricular function post-surgery.
- Left ventricular regional wall motion is a key indicator of myocardial health.
Purpose:
- To compare the impact of cold crystalloid versus tepid blood cardioplegia on left ventricular regional wall motion after CABG.
- To investigate the role of pre-existing collateral artery grading in predicting postoperative wall motion.
Summary:
- A clinical study involving 43 patients undergoing CABG compared cold crystalloid cardioplegia with topical ice slush versus tepid blood cardioplegia.
- Patients receiving crystalloid cardioplegia showed a significantly higher incidence of left ventricular wall motion deterioration (p=0.008).
- Deterioration was more pronounced in the crystalloid group with absent collateral arteries (grade 0), unlike the blood group.
Impact:
- Tepid blood cardioplegia appears to offer superior myocardial protection compared to cold crystalloid cardioplegia during CABG.
- This finding has implications for optimizing cardioplegia strategies to improve patient outcomes.
- Understanding collateral circulation's role can refine patient selection and surgical planning for enhanced ventricular recovery.
Abstract:
This clinical study was conducted to determine whether different techniques of cardioplegic protection reflected left ventricular regional wall motion after CABG. A total of 43 patients with more than 90% stenosis of the LAD (seg 6 and/or 7) before CABG, who had patent grafts were allocated to two groups: namely, the crystalloid group, comprised of 23 patients given cold crystalloid cardioplegia and topical ice slush, and the blood group, comprised of 20 patients given tepid blood cardioplegia delivered intermittently antegrade. Each group was divided into two subgroups according to whether the left ventricular regional wall motion showed no change or deterioration after CABG. We also examined the relationship between the grading of the collateral artery before CABG and the postoperative ventricular regional wall motion. The number of patients who showed deterioration after CABG was higher in the crystalloid group than in the blood group (p = 0.008). Moreover, patients in the crystalloid group whose collateral artery had been graded as 0 before CABG tended to show deterioration of left ventricular local wall motion after CABG (p = 0.07). Whereas those patients in the blood group did not. In conclusion, the incidence of deterioration after CABG was higher in the crystalloid group than in the blood group.