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Crystalloid versus blood cardioplegia in coronary by-pass surgery. A prospective, randomized, controlled study in 100
W Wandschneider1, S Winter, M Thalmann
1Department of Cardiovascular and Vascular Surgery, General Hospital Lainz, Vienna, Austria.
Insights
Cold blood cardioplegia significantly reduces perioperative infarction and 30-day mortality in coronary artery bypass grafting (CABG) compared to crystalloid solutions. This method offers a safe and effective alternative for cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardioplegia Solutions
Background:
- Coronary artery bypass grafting (CABG) is a common cardiac surgery procedure.
- The choice of cardioplegia solution impacts myocardial protection during surgery.
- Blood cardioplegia has been proposed as an alternative to crystalloid solutions.
Purpose of the Study:
- To compare the efficacy of cold blood cardioplegia versus standard crystalloid cardioplegia in routine CABG.
- To evaluate the impact of different cardioplegia solutions on perioperative outcomes.
Main Methods:
- Prospective randomized trial with 100 adult patients undergoing CABG.
- Patients were assigned to receive either cold blood cardioplegia (Group A) or standard crystalloid cardioplegia (Group B).
- Combined antegrade and retrograde cardioplegia administration with warm reperfusion in the blood cardioplegia group.
Main Results:
- Blood cardioplegia group showed significantly lower rates of perioperative infarction (3.7% vs 6.3%) and 30-day mortality (0% vs 3.2%).
- Reduced need for inotropic support post-operatively in the blood cardioplegia group.
- No significant difference in aortic cross-clamp time, cardioplegic solution volume, or hospital stay between groups.
Conclusions:
- Cold blood cardioplegia is superior to crystalloid cardioplegia for myocardial protection in routine CABG.
- Antegrade and retrograde delivery of cold blood cardioplegia with warm reperfusion is a safe and effective technique.
- This approach yields improved clinical outcomes in patients undergoing coronary artery bypass grafting.
Abstract:
In a prospective randomized trial we investigated the benefit of blood versus asanguinous cardioplegia in routine coronary by-pass grafting. One hundred consecutive adult patients were randomly assigned to two groups: Group A (53 patients) received cold blood cardioplegia and group B (47 patients) had standard St. Thomas solution. In all patients we combined ante- and retrograde administration, in group A warm reperfusion was carried out before aortic declamping. Aortic cross clamp times, amount of cardioplegic solution and blood potassium levels at the end of cardio-pulmonary by-pass were higher in group A than in group B. The need for inotropic support at the end of the operation as well as in the postoperative period was more frequent in the crystalloid cardioplegia group. The occurrence of atrial fibrillation showed no clear correlation to the kind of cardioplegia used. Perioperative infarction was less frequent in the blood cardioplegia group (3.7% vs 6.3%; p < 0.01) and 30-day-mortality was nil (0% vs 3.2%; p < 0.01). Hospital stay did not differ between the two groups. In this clinical trial we could demonstrate the superiority of blood versus crystalloid cardioplegia in routine coronary by-pass grafting. Ante- and retrograde delivery of cold blood cardioplegia followed by warm reperfusion is a safe and simple method yielding satisfactory results.