Myocardial temperature mapping. Improved intraoperative myocardial preservation

Area of Science:

• Cardiovascular Surgery
• Cardiac Anesthesia
• Cardiothoracic Medicine

Background:

• Myocardial preservation is critical during aorta-coronary bypass grafting (CABG).
• Traditional methods may lead to non-uniform myocardial cooling, increasing risks.
• Optimizing cardioplegia delivery and temperature monitoring is essential.

Purpose of the Study:

• To introduce and evaluate an improved intraoperative myocardial preservation technique for CABG.
• To ensure uniform myocardial cooling, especially past stenosed arteries.
• To assess the impact of this technique on perioperative outcomes.

Main Methods:

• Utilized a pressure-regulated system for controlled cardioplegia solution delivery (1 L) via a 4°C coil.
• Implemented midmyocardial wall temperature monitoring for regional assessment.
• Sequentially performed distal anastomoses starting with the warmest myocardial regions.
• Administered additional cardioplegia (400 ml) after each distal anastomosis.

Main Results:

• Zero perioperative myocardial infarctions in the new technique group (Group I) versus 5.2% in the control group (Group II).
• Reduced cardiac deaths from 8.2% (Group II) to 2.0% (Group I).
• Statistical significance achieved for both infarction and mortality reductions (p < 0.05).

Conclusions:

• The improved technique, combining pressure-regulated cardioplegia and myocardial temperature mapping, enhances myocardial preservation.
• This approach significantly lowers the incidence of perioperative myocardial infarction and cardiac death in CABG patients.
• Optimized myocardial cooling and targeted cardioplegia delivery are key to improved surgical outcomes.