Clinical advantages of papaverine cardioplegia

To determine the efficacy of papaverine in improving myocardial protection by causing a uniform distribution of the cardioplegic solution, a prospective study was carried out in 200 consecutive patients undergoing various open heart procedures. Several parameters (creatine kinase MB, electron microscopy of myocardium, perioperative myocardial infarction rate, frequency of postoperative arrhythmias) were monitored and compared with those of a control group which consisted of the previous 200 consecutive patients in whom the same cardioplegic solution was used, but without papaverine. In the papaverine group the operative mortality due to low cardiac output was 0.5% compared to 3%, and the spontaneous recovery of the heart after release of the aortic cross-clamp was 89% compared to 47% in the control group (P less than 0.01). The perioperative myocardial infarction rate was 5% and the incidence of postoperative temporary arrhythmias was also 5% in the papaverine group, while in the control group the perioperative myocardial infarction rate was 10% and the postoperative arrhythmia incidence was 13% (P less than 0.01).