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Comparison between blood and crystalloid cardioplegia in patients with left ventricular dysfunction undergoing
R Brát1, J Tosovský, J Januska
1Department of Cardiac Surgery, University Hospital Ostrava. radim.brat@fnspo.cz
Insights
Cold blood cardioplegia offers superior myocardial protection during coronary artery bypass grafting (CABG) for patients with left ventricular dysfunction. This method resulted in better early hemodynamic function and reduced enzyme release compared to crystalloid cardioplegia.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardioplegia Solutions
Background:
- Left ventricular dysfunction presents challenges during coronary artery bypass grafting (CABG).
- Effective myocardial protection is crucial for patients with reduced ejection fraction undergoing CABG.
- Comparing blood and crystalloid cardioplegia is essential for optimizing perioperative outcomes.
Purpose of the Study:
- To compare the perioperative myocardial protective effects of cold blood cardioplegia versus cold crystalloid cardioplegia.
- To evaluate hemodynamic parameters, enzyme release, and clinical outcomes in patients with left ventricular dysfunction undergoing CABG.
Main Methods:
- Sixty patients with left ventricular ejection fraction < 35% undergoing CABG were randomized into two groups.
- Group 1 received cold blood cardioplegia; Group 2 received cold crystalloid cardioplegia, both delivered antegrade.
- Hemodynamic data (LVSWI, RVSWI), enzyme release, and clinical events were monitored postoperatively.
Main Results:
- No significant difference in mortality, perioperative myocardial infarction, arrhythmias, or intra-aortic balloon pump use between groups.
- The blood cardioplegia group demonstrated significantly better early hemodynamic data (LVSWI, RVSWI).
- Significantly lower enzyme release was observed in the blood cardioplegia group.
Conclusions:
- Cold blood cardioplegia provides superior perioperative myocardial protection compared to crystalloid cardioplegia in patients with left ventricular dysfunction undergoing CABG.
- Blood cardioplegia facilitates earlier restoration of myocardial function, which is particularly beneficial for high-risk patients.
Abstract:
This study was done to compare the protective effect of blood and crystalloid cardioplegia in patients with left ventricular dysfunction undergoing coronary artery bypass grafting (CABG). Sixty consecutive patients with left ventricular ejection fraction < 35% scheduled for CABG with the use of cardiopulmonary bypass without additional procedures were randomly divided into two groups. In the first group we used cold blood cardioplegia, in the second group cold crystalloid cardioplegia, both delivered only ortogradely. We measured hemodynamic data in early hours after operation, enzyme release and we collected other clinical data which could be influenced by perioperative myocardial protection. There was no death in either group. We also didn't find any significant difference in incidence of perioperative myocardial infarction, arrhythmias and use of intraaortic balloon pumping between both groups. In an early hours after operation in the group with blood cardioplegia we found significantly better hemodynamic data (LVSWI, RVSWI) and significantly lower enzyme release. We conclude, that cold blood cardioplegia shows superior perioperative myocardial protection resulting in earlier restoration of myocardial function. This difference could be important in patients with high degree of left ventricular dysfunction.