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Long term left ventricular systolic function assessment following CABG. A prospective, randomised study. Blood versus
Z Gasior1, M Krejca, P Szmagala
11st Cardiac Surgery Department, Silesian School of Medicine, Katowice, Poland.
Insights
Blood cardioplegia offers no advantage over crystalloid cardioplegia for left ventricular systolic function after coronary artery bypass grafting (CABG). However, patients with low left ventricular ejection fraction (LVEF) show greater functional improvement post-CABG.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiomyopathy Research
Background:
- Investigating the impact of blood cardioplegia versus crystalloid cardioplegia in coronary artery bypass grafting (CABG).
- Focusing on patients with both good and poor left ventricular (LV) function.
- Evaluating postoperative hemodynamics and clinical data.
Purpose of the Study:
- To compare the efficacy of antegrade/retrograde blood cardioplegia versus crystalloid cardioplegia.
- To assess myocardial protection strategies in patients undergoing CABG.
- To analyze the influence on left ventricular systolic function.
Main Methods:
- A prospective randomized study of 122 patients undergoing CABG.
- Patients were grouped by baseline left ventricular ejection fraction (LVEF <40% or >40%).
- Echocardiography was used to assess LV function pre- and post-operatively at multiple time points.
Main Results:
- Both cardioplegia methods resulted in improved quality of life.
- Patients with low LVEF (Group I) demonstrated consistent improvement in LVEF and wall motion score index (WMSI).
- No significant differences in postoperative LV systolic function were found between blood and crystalloid cardioplegia subgroups.
Conclusions:
- Blood cardioplegia does not influence postoperative LV systolic function compared to crystalloid cardioplegia during CABG.
- Patients with lower baseline LVEF experience greater improvement in LV function after CABG.
- Antegrade/retrograde delivery methods are utilized for both cardioplegia types.
Background:
In an effort to define the role of blood cardioplegia delivered in antegrade/retrogade fashion in patients with either good or poor left ventricular function undergoing elective coronary artery bypass surgery, we initiated a prospective randomised study in which postoperative hemodynamics besides clinical data were compared in patients administered antegrade/retrograde crystalloid cardioplegia.
Methods:
To compare the efficiency of two methods of myocardial protection--cold crystalloid ante/retro cardioplegia and cold blood ante/retro cardioplegia in two groups of patients with high and low LVEF--we randomised 122 patients for CABG. The potential improvement in left ventricular systolic function assessed by echocardiography and the same clinical data were the end points of the study. Patients were divided into group I (47 patients, LVEF <40%) and group II (75 patients, LVEF >40%). Pathologic antecedents and preoperative clinical conditions were similar in both randomised subgroups Ia, IIa (crystalloid cardioplegia) and subgroups Ib, IIb (blood cardioplegia). The following parameters were measured: left atrium diameter (LA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), left ventricular wall motion score index (WMSI), and area asynergy (AA). All patients underwent echocardiography: A--prior the CABG, B--2-6 weeks postoperatively, C--3 months postoperatively, D--6 months postoperatively, E--1 year postoperatively.
Results:
The results of clinical assessment in both groups showed improvement of quality of life. The constant improvement of LVEF and WMSI was observed in group I in contrast to group II. There were no significant differences in postoperative left ventricular systolic function between subgroups Ia and Ib or IIa and IIb.
Conclusions:
The use of blood cardioplegia, instead of crystalloid cardioplegia, when used in the ante/retrograde fashion during CABG has no influence on postoperative left ventricular systolic function. The improvement in left ventricular systolic function following CABG is greater in patients with low LVEF in contrast to patients with high LVEF.