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Does the type of venous drainage or cardioplegia affect postoperative conduction and atrial arrhythmias?
Insights
Blood cardioplegic solution significantly reduces conduction disturbances and atrial arrhythmias after coronary bypass surgery. High-volume crystalloid solutions offer less protection, with most disturbances being temporary.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Electrophysiology
Background:
- Postoperative conduction disturbances and atrial arrhythmias are common complications following coronary bypass surgery.
- The type and volume of cardioplegic solution used can influence the incidence of these complications.
Purpose of the Study:
- To compare the incidence of postoperative conduction disturbances and atrial arrhythmias among different cardioplegic solutions and administration techniques.
- To determine the protective effects of blood cardioplegic solution versus crystalloid solutions.
Main Methods:
- Five groups of patients undergoing coronary bypass surgery received different cardioplegic solutions (blood vs. crystalloid, high-volume vs. low-volume) and vena cava management.
- Postoperative electrocardiograms were analyzed for conduction disturbances and atrial arrhythmias.
Main Results:
- Group I (blood cardioplegic solution) showed a significantly lower incidence of conduction disturbances (12%) compared to crystalloid groups (26.2%-62.1%).
- High-volume crystalloid solutions (Groups IV and V) had a higher incidence of conduction disturbances than low-volume solutions (Groups II and III).
- Group I also had the lowest incidence of postoperative atrial arrhythmias (3.8%).
Conclusions:
- Blood cardioplegic solution provides superior protection against postoperative conduction disturbances and atrial arrhythmias after coronary bypass surgery.
- High-volume crystalloid cardioplegic solution offers the least protection against conduction disturbances.
Abstract:
Five consecutive patient groups undergoing coronary bypass surgery were studied for postoperative conduction disturbances and atrial arrhythmias. Group I (50 patients) had blood cardioplegic solution (25 meq/liter potassium) and unsnared venae cavae, group II (156 patients) had low-volume crystalloid cardioplegic solution (25 meq/liter potassium) and unsnared venae cavae, group III (56 patients) was similar to group II except that a single cavoatrial venous cannula was used instead of two separate cannulas, group IV (218 patients) had high-volume crystalloid cardioplegic solution (25 meq/liter potassium) and snared venae cavae, and group V (37 patients) was the same as group IV except that the cardioplegic solution contained 10 meq/liter potassium after the first dose, which contained 25 meq/liter. All postoperative electrocardiograms were analyzed for conduction disturbances and atrial arrhythmias. The results showed a significantly lower incidence of conduction disturbances in group I (12%) as compared with groups II to IV. In addition, groups IV and V (high-volume crystalloid cardioplegic solution) had a significantly higher incidence of conduction disturbances than groups II and III (lower-volume crystalloid solution) (55.0% and 62.1% vs 26.2% and 35.1%, respectively). The majority of these disturbances were temporary. Group I also had the lowest incidence of postoperative atrial arrhythmias (3.8%). There was no significant difference between the groups receiving high- and low-volume crystalloid solution. It is concluded that blood cardioplegic solution affords the best protection against postoperative conduction disturbances and atrial arrhythmias. High-volume crystalloid cardioplegic solution affords the least protection against conduction disturbances but has no effect on atrial arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)