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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.
Insights
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.
Abstract:
The effects of adding colloid (dextran 40, Rheomacrodex) to cardioplegic solution were studied in 55 men undergoing bypass grafting for uncomplicated coronary artery disease. The patients were randomly allocated to group I (n = 27), in which 35 g dextran 40 was added to the St Thomas II cardioplegic solution, or group II (n = 28), which received a standard crystalloid cardioplegic solution. The groups were comparable in regard to preoperative and intraoperative data. In group I the pulmonary vascular resistance index was transiently elevated after extracorporeal circulation and both oxygen consumption and arteriovenous oxygen content difference 2 hours postoperatively were greater than in group II, suggesting better microcirculation. Postoperative normalization of the chest X-rays was more rapid in group I. The clinical course was similar in the two groups.