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[Comparative study of cardioplegia and intermittent cross-clamping in myocardial revascularization surgery]
F B Jatene1, H P Ferreira, J A Ramires
1Instituto do Coraçăo do Hospital das Clínicas, FMUSP.
Insights
Both intermittent aortic cross-clamping (IACC) and cold hyperkalemic solution (CHS) effectively protect the heart during coronary artery bypass grafting (CABG). These myocardial preservation methods showed similar outcomes in both immediate and long-term follow-ups for elective CABG patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Myocardial Protection Strategies
Background:
- Coronary artery bypass grafting (CABG) necessitates effective myocardial preservation.
- Two primary methods, intermittent aortic cross-clamping (IACC) and cold hyperkalemic solution (CHS), are employed.
- Comparing their efficacy is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To compare the effectiveness of IACC versus CHS for myocardial preservation during elective CABG.
- To evaluate both immediate postoperative and long-term outcomes.
Main Methods:
- Retrospective study of 163 patients undergoing elective CABG.
- Group I (n=93) received IACC; Group II (n=70) received CHS (St. Thomas solution).
- Patients were followed for up to 61 months, assessing myocardial ischemia, infarction, drug use, recovery time, symptoms, and late mortality.
Main Results:
- No in-hospital deaths were recorded.
- Perioperative myocardial infarction rates were similar (2.1% for IACC, 1.4% for CHS).
- Long-term follow-up (median 38 months) showed comparable cardiac death rates and coronary insufficiency symptoms between groups.
Conclusions:
- Both IACC and CHS are efficient and comparable methods for myocardial protection in elective CABG.
- The choice between IACC and CHS does not significantly impact immediate or late patient outcomes.
Purpose:
To compare the effects of two methods for myocardial preservation during coronary artery by pass graft (CABG): the intermittent aortic cross-clamping (IACC) and the cold hyperkalemic solution (CHS).
Patients And Methods:
One hundred and sixty-three patients operated for CABG between October/83 to May/84 were studied retrospectively. Those operated in emergency situations, reoperations and those who required concomitant additional procedures were excluded. The surgical technique used in both groups was essentially the same. Group I comprised 93 cases (40-70 years-old, median 57.7% y; 86% male) in which IACC were used. Group II comprised 70 cases (37-72 years old, median 67.7 y; 80% male) in which CHS (St. Thomas) was injected into the aortic root. The patients were evaluated in the immediate postoperative period at 3, 6, 12 months and then in variable periods until the 61 months of late follow-up. Myocardial ischemia and infarction, the use of drugs and the hospital time recovery were evaluated. The occurrence of symptoms, return to work, physical capacity, reinternations, reoperations and late deaths were evaluated in the late follow-up.
Results:
During hospital period, no death was observed. Perioperative myocardial infarct was similar in both groups (group I = 2.1% and group II = 1.4%) statistical difference in the others parameters was observed. Of 95.5% of the patients who had postoperative observations, 80% had a late follow-up ranged from 30 to 61 months (median 38 months). One patient of each group had a cardiac death. In both groups (group I--1 patient and group II--4 patients) coronary insufficiency symptoms related were present and no statistical difference in the others parameters was observed.
Conclusion:
CHS or IACC were efficient and similar methods for myocardial protection in an elective group of patients submitted to a CABG in the immediate and late follow-up.