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Interrupted warm blood cardioplegia for coronary artery bypass grafting
T Isomura1, K Hisatomi, T Sato
1Second Department of Surgery, Kurume University Hospital, Fukuoka, Japan.
Insights
Interrupted warm blood cardioplegia improved myocardial metabolism and spontaneous heart rhythm recovery after coronary bypass surgery compared to cold crystalloid cardioplegia. This approach shows promise for enhanced surgical outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardioplegia Delivery
- Myocardial Metabolism
Background:
- Continuous cardioplegia delivery can be interrupted during surgery for visualization.
- Interrupted cardioplegia may impact myocardial metabolism and clinical outcomes.
Purpose of the Study:
- To investigate the effects of interrupted antegrade warm blood cardioplegia on myocardial metabolism and clinical results.
- To compare warm blood cardioplegia with cold crystalloid cardioplegia in isolated coronary bypass surgery.
Main Methods:
- Fifty-five patients undergoing coronary bypass surgery received either warm blood cardioplegia (n=29) or cold crystalloid cardioplegia (n=26) antegradely.
- Measurements included myocardial oxygen consumption, lactate extraction, CK-MB, and MDA during reperfusion.
- Postoperative assessments included serum CK-MB, cardiac output, and need for inotropic support.
Main Results:
- Warm blood cardioplegia showed significantly greater myocardial oxygen extraction one minute after reperfusion (P < 0.02).
- Spontaneous return to sinus rhythm occurred in 90% of patients receiving warm cardioplegia versus 15.4% with cold (P < 0.01).
- No significant differences in CK-MB or MDA release were observed postoperatively, though more patients with poor left ventricular function received warm cardioplegia (P < 0.05).
Conclusions:
- Interrupted antegrade warm blood cardioplegia demonstrates favorable myocardial metabolic effects and improved early recovery of spontaneous heart rhythm.
- This method appears safe and effective for isolated coronary bypass surgery, despite potential considerations for patients with pre-existing left ventricular dysfunction.
Abstract:
Continuous warm blood cardioplegia has been used with good clinical outcome in both antegrade and retrograde delivery. However, the continuous delivery of cardioplegia is sometimes interrupted for adequate visualization and flow is not constant with heart manipulation during operation. We studied the effects of interrupted antegrade delivery of warm blood cardioplegia on myocardial metabolism and clinical results after surgery. Fifty-five patients undergoing isolated coronary bypass surgery received warm blood cardioplegia (n = 29) or cold crystalloid cardioplegia (n = 26) in an antegrade fashion. During reperfusion, myocardial oxygen consumption, lactate extraction, creatinine kinase isoenzyme (CK-MB), and malondialdehyde (MDA) were measured. Post-operatively, serum CK-MB and cardiac output (CO) were determined over a period of time. Myocardial oxygen extraction in the warm group was significantly greater than in the cold group 1 min after reperfusion (P < 0.02). The results revealed a tendency for patients in the warm group to have prior lactate extraction, although the difference did not reach statistic difference (P < 0.10). After removal of the aortic cross-clamp, the heart returned to sinus rhythm spontaneously in 90% of the patients with warm cardioplegia and 15.4% of those with a cold heart (P < 0.01). Postoperatively, there was no significant CK-MB or MDA release in either group except for one patient with perioperative myocardial infarction. After operation inotropic support was required for two and one patient in the warm and cold groups, respectively, although there were significantly more patients with poor left ventricular function in the warm, than in the cold, group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)