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[Cardioplegic arrest and intermittent aortic clamping: comparison in coronary artery bypass graft]
1Deutsches Herzzentrum München, Klink für Herz- und Gefässchirurgie.
Insights
Coronary artery bypass graft (CABG) surgery outcomes were similar between cardioplegic arrest and intermittent aortic cross-clamping. Optimal reperfusion times are crucial for minimizing arrhythmia and intubation duration in CABG patients.
Area of Science:
- Cardiac Surgery
- Cardiovascular Research
- Thoracic Surgery
Background:
- Coronary artery bypass graft (CABG) surgery is a common procedure.
- Myocardial protection strategies are vital for patient outcomes.
- Two primary methods include cardioplegic arrest and intermittent aortic cross-clamping.
Purpose of the Study:
- To compare the clinical outcomes of CABG using cardioplegic arrest versus intermittent aortic cross-clamping.
- To investigate the impact of reperfusion and cross-clamping times on postoperative complications.
Main Methods:
- A randomized trial involving 427 patients undergoing CABG.
- Group A (269 patients) received myocardial protection via cardioplegic solution (Bretschneider).
- Group B (158 patients) underwent surgery with intermittent aortic cross-clamping.
Main Results:
- No significant differences in early mortality, low output syndrome, myocardial infarction, ICU stay, intubation length, arrhythmia, or inotropic support were observed between groups.
- The reperfusion-to-cross-clamping time ratio (R/C-ratio) was higher in the intermittent cross-clamping group.
- Specific R/C-ratios and cross-clamping/reperfusion durations correlated with increased arrhythmia and intubation times in both groups, particularly with shorter reperfusion periods.
Conclusions:
- Both cardioplegic arrest and intermittent aortic cross-clamping yield comparable early postoperative results in CABG.
- Maintaining adequate reperfusion, ideally at least 20 minutes or an R/C-ratio over 0.60, is essential for reducing postoperative complications.
- Optimizing reperfusion strategies can improve patient recovery following CABG surgery.
Abstract:
427 randomized patients undergoing coronary artery bypass graft (CABG) were divided into two groups. In Group A (269 patients), myocardial protection was achieved using cardioplegic solution (Bretschneider). Group B (158 patients) was operated with intermittent aortic cross-clamping. Between both groups there was no significant difference in early postoperative mortality rates, incidence of postoperative low output syndrome, perioperative myocardial infarctions, length of ICU-stay, length of intubation, incidence of arrhythmia, and inotropic requirements. The ratio of reperfusion time divided by aortic cross-clamping time (R/C-ratio) in Group B (1.06 + 1.17) was larger than in Group A (0.49 + 0.17), which could explain this result. In Group A significantly larger incidence of postoperative arrhythmia was recognized, if reperfusion time was shorter than 20 minutes. Also in Group A, longer postoperative intubation was required with R/C-ratio under 0.60. In Group B longer intubation was needed postoperatively with aortic cross-clamping time longer than 30 minutes, reperfusion time shorter than 30 minutes, or R/C-ratio under 0.80. In conclusion, reperfusion should be continued at least for 20 minutes and if possible, for the length equivalent to R/C-ratio over 0.60 in CABG with presently widely used cardioplegic arrest.