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Terminal warm blood cardioplegia improves the recovery of myocardial electrical activity. A retrospective and
Y Hattori1, Z Yang, S Sugimura
1Department of Thoracic Surgery, Fujita Health University School of Medicine, Aichi, Japan.
Insights
Terminal warm blood cardioplegia significantly improved spontaneous sinus rhythm recovery and reduced arrhythmias after cardiac surgery. This method enhanced postoperative electrophysiological cardiac recovery in patients undergoing bypass grafting or valve replacement.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
Background:
- Myocardial protection is crucial during cardiac surgery.
- Optimizing recovery of cardiac electrical activity is a key surgical goal.
Purpose of the Study:
- To evaluate the impact of terminal warm blood cardioplegia on postoperative cardiac electrophysiological recovery.
- To compare outcomes between patients receiving different cardioplegia strategies.
Main Methods:
- Analysis of 191 patients undergoing coronary artery bypass grafting (CABG) or prosthetic heart valve replacement.
- Patients divided into three groups based on myocardial protection: cold crystalloid cardioplegia alone, cold crystalloid plus terminal warm blood cardioplegia, and a mixed cold/warm blood cardioplegia strategy.
- Comparison of spontaneous rhythm recovery, arrhythmias, and pacing requirements.
Main Results:
- Groups receiving terminal warm blood cardioplegia showed significantly higher rates of spontaneous sinus rhythm recovery post-declamping.
- Patients without terminal warm blood cardioplegia had a higher incidence of ventricular fibrillation/tachycardia and required more temporary pacing.
- Postoperative atrial fibrillation was reduced in patients with terminal warm blood cardioplegia undergoing valve replacement.
Conclusions:
- Terminal warm blood cardioplegia significantly enhances postoperative electrophysiological cardiac recovery.
- This strategy is associated with improved spontaneous rhythm restoration and reduced arrhythmias.
- Warm blood cardioplegia represents an effective method for myocardial protection during cardiac surgery.
Objective:
The effect of terminal warm blood cardioplegia was analyzed in 191 patients undergoing either coronary artery bypass grafting (CABG) or prosthetic heart valve replacement between Jan. 1990 and Dec. 1995.
Methods:
Patients were subdivided into 3 historical cohorts based on the method of myocardial protection: Group A (n = 106), multidose cold crystalloid glucose-potassium cardioplegia, alone; Group B (n = 37), cold crystalloid glucose-potassium cardioplegia plus terminal warm blood cardioplegia, Group C (n = 48), cardioplegia induction with cold crystalloid glucose-potassium cardioplegia, maintenance with multidose cold blood cardioplegia, and terminal warm blood cardioplegia.
Results:
Of patients undergoing CABG, 5.6% of group A, 70.4% of group B, and 86.7% of group C spontaneously resumed sinus rhythm after aortic declamping, as did 9.1% of group A, 60.0% of group B, and 55.6% of group C of patients undergoing prosthetic heart valve replacement. The incidence of spontaneous recovery was significantly better in groups B and C than in group A (p < 0.05). Over 90% of patients without terminal warm blood cardioplegia developed ventricular fibrillation or tachycardia requiring electrical cardioversion (p < 0.05). Postoperatively, patients without terminal warm blood cardioplegia required temporary epicardial pacing more frequently than those with terminal warm blood cardioplegia (p < 0.05). In patients undergoing prosthetic heart valve replacement, groups B and C, the incidence of postoperative atrial fibrillation was significantly lower than in group A.
Conclusion:
Terminal warm blood cardioplegia thus promoted better postoperative electrophysiological cardiac recovery.
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