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Intermittent aortic cross-clamping and cold crystalloid cardioplegia for low-risk coronary patients
H C Alhan1, H Karabulut, R Tosun
1Siyami Ersek Thoracic and Cardiovascular Surgery Center, University of Marmara, Instanbul, Turkey.
Insights
For low-risk patients undergoing first-time coronary artery bypass grafting, both intermittent aortic cross-clamping and cold crystalloid cardioplegia are safe and effective. No significant differences were observed in key clinical outcomes between the two methods.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
Background:
- Blood cardioplegia enhances myocardial oxygen uptake and function in high-risk patients.
- The efficacy of blood cardioplegia versus intermittent aortic cross-clamping and crystalloid cardioplegia in low-risk patients remains debated.
Purpose of the Study:
- To compare the safety and efficacy of intermittent aortic cross-clamping and cold crystalloid cardioplegia in low-risk patients undergoing first-time coronary artery bypass grafting.
Main Methods:
- A retrospective analysis of 399 low-risk patients (1993-1995) using cold crystalloid cardioplegia or intermittent aortic cross-clamping.
- A prospective randomized trial of 40 low-risk patients comparing the two techniques, assessing hemodynamic, biochemical, and ultrastructural changes.
Main Results:
- Overall mortality was 0.25%, perioperative myocardial infarction was 1.5%, and need for intraaortic balloon pumps or inotropic agents was low.
- No statistically significant differences were found between the intermittent aortic cross-clamping and cold crystalloid cardioplegia groups for the studied clinical endpoints.
Conclusions:
- Both intermittent aortic cross-clamping and cold crystalloid cardioplegia are safe and viable options for myocardial protection in low-risk patients undergoing first-time coronary artery bypass grafting.
Background:
Blood cardioplegic strategies have been shown to increase myocardial oxygen uptake, replenish depleted energy stores, and improve myocardial function and survival in the high-risk subset of patients. However, the superiority of these techniques over intermittent aortic cross-clamping and crystalloid cardioplegia in low-risk patients is still controversial.
Methods:
This study consisted of two parts. In the first part, we assessed the results of a recent cohort of 399 consecutive low-risk patients undergoing their first coronary artery bypass grafting between 1993 and 1995 using cold crystalloid cardioplegia (n = 128) and intermittent aortic cross-clamping (n = 271). In the second part of the study, 40 consecutive low-risk patients undergoing elective first time coronary artery bypass grafting were randomly divided into two equal groups. One group received cold crystalloid cardioplegia and the other group had myocardial management with intermittent aortic cross-clamping. The two groups were compared with respect to hemodynamic, biochemical and ultrastructural changes.
Results:
The overall mortality rate, the perioperative myocardial in the need for intraaortic balloon pumps, and the need for inotropic agents were 0.25%, 1.5%, 1%, and 5.8%, respectively. No significant differences were observed between the groups with respect to these clinically defined end points.
Conclusions:
Both intermittent aortic cross-clamping and cold crystalloid cardioplegia techniques may be used safely in low-risk patients undergoing first-time coronary artery bypass grafting.