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Colloid versus crystalloid cardioplegia. A prospective, randomized clinical study.
H Lindberg1, E Ovrum, E A Holen
1Department of Cardiovascular Surgery, Rikshospitalet, National Hospital of Norway, Oslo.
Scandinavian Journal of Thoracic and Cardiovascular Surgery
|January 1, 1989
Summary
Adding dextran 40 (Rheomacrodex) to cardioplegic solution improved microcirculation and chest X-ray recovery after coronary artery bypass grafting. Clinical outcomes remained similar between groups.
Area of Science:
- Cardiovascular Surgery
- Cardiothoracic Anesthesia
- Biomaterials Science
Background:
- Coronary artery bypass grafting (CABG) requires myocardial protection during surgery.
- Cardioplegic solutions are crucial for preserving heart function during cardiac arrest.
- Optimizing cardioplegic solution composition may enhance postoperative recovery.
Purpose of the Study:
- To investigate the impact of adding dextran 40 (Rheomacrodex) to a crystalloid cardioplegic solution (St Thomas II) in CABG patients.
- To assess the effects on microcirculation and early postoperative recovery.
Main Methods:
- A randomized controlled trial involving 55 male patients undergoing CABG.
- Group I (n=27) received St Thomas II cardioplegic solution with 35g dextran 40.
- Group II (n=28) received standard crystalloid St Thomas II cardioplegic solution.
Main Results:
- Patients receiving dextran 40 showed transiently elevated pulmonary vascular resistance index post-extracorporeal circulation.
- Oxygen consumption and arteriovenous oxygen content difference were higher 2 hours postoperatively in the dextran 40 group, indicating improved microcirculation.
- Faster normalization of chest X-rays was observed in the dextran 40 group.
Conclusions:
- Addition of dextran 40 to cardioplegic solution may enhance myocardial microcirculation and accelerate pulmonary recovery after CABG.
- While microcirculatory benefits were suggested, overall clinical outcomes were comparable between groups.