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Experience with warm blood cardioplegia in 480 patients
G A Tolis1, G Astras, N Sfyras
1Department of Cardiothoracic Surgery, Diagnostic and Therapeutic Center of Athens HYGEIA, S.A., Greece.
Insights
Retrograde continuous warm blood cardioplegia offers excellent myocardial protection during open-heart surgery. This method demonstrated low mortality and minimal complications in a large patient cohort undergoing various cardiac procedures.
Area of Science:
- Cardiovascular Surgery
- Cardioplegia Techniques
- Cardiac Anesthesia
Background:
- Open-heart procedures require effective myocardial protection.
- Continuous warm blood cardioplegia is an alternative to cold crystalloid methods.
- Retrograde delivery offers potential advantages for myocardial perfusion.
Purpose of the Study:
- To evaluate the efficacy of continuous warm blood cardioplegia, particularly retrograde delivery, in open-heart surgery.
- To assess myocardial protection, perioperative outcomes, and complications associated with this technique.
Main Methods:
- A prospective study of 480 patients undergoing open-heart procedures from March 1992 to July 1993.
- Patients received either antegrade or retrograde continuous warm blood cardioplegia.
- Procedures included coronary artery bypass grafts (CABG) and valve replacement.
Main Results:
- The 30-day postoperative mortality rate was 2.9%.
- Perioperative myocardial infarction occurred in 5.6% of CABG patients; none after valve replacement.
- No phrenic nerve injury or wound infection observed; one coronary sinus perforation.
Conclusions:
- Continuous warm blood cardioplegia, especially when delivered retrogradely, provides excellent myocardial protection.
- The technique is associated with favorable outcomes and low complication rates in diverse open-heart surgeries.
Abstract:
From 1 March 1992 too 31 July 1993 (17 months), 480 consecutive patients underwent various open-heart procedures under anterograde (83 patients) or retrograde (397 patients) or retrograde (397 patients) continuous warm blood cardioplegia. Some 352 patients (73.3%) had isolated coronary artery bypass grafts (CABG) and 117 (24.3%) had valve replacement either isolated (96) or in combination with other operations (21). Two patients had CABG and ventricular aneurysmectomy, eight had correction of congenital defects, and one had resection of left atrial myxoma. The 30-day postoperative mortality rate was 2.9% (14 deaths). In four patients the cause of death was not cardiogenic. An intra-aortic balloon was used in 11 patients following CABG (3.1%) with six survivors. Perforation of the coronary sinus occurred in one patient. Perioperative myocardial infarction was observed in 5.6% of patients after CABG. No myocardial infarction occurred after valve replacement. Phrenic nerve injury and wound infection were not observed. These results indicate that warm blood cardioplegia, especially when delivered retrogradely, provides excellent myocardial protection of both ventricles during various open-heart procedures.