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Randomized trial comparing intermittent antegrade warm blood cardioplegia with multidose cold blood cardioplegia for
R Landymore1, J T Murphy, R Hall
1Department of Cardiac Sciences, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia.
Insights
Warm blood cardioplegia (WBC) and cold blood cardioplegia (CBC) offer similar myocardial protection during coronary artery bypass surgery. Both methods demonstrated comparable recovery of heart function and metabolic status post-procedure.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Myocardial Protection
Background:
- Coronary artery bypass grafting (CABG) requires effective myocardial protection.
- Different cardioplegia solutions and temperatures are used to preserve heart function during surgery.
- Warm blood cardioplegia (WBC) and cold blood cardioplegia (CBC) are two such techniques.
Purpose of the Study:
- To compare the efficacy of antegrade multidose warm blood cardioplegia (WBC) versus cold blood cardioplegia (CBC) in protecting the myocardium during CABG.
- To evaluate myocardial metabolic and functional recovery, and clinical outcomes between the two cardioplegia strategies.
Main Methods:
- Forty patients undergoing CABG were randomized to receive either WBC or CBC.
- Cardioplegia was infused multidose every 10 minutes during cardiac arrest.
- Core body temperature was maintained at 37°C during extracorporeal circulation for both groups.
- Hemodynamic and metabolic parameters were assessed before bypass and up to 7 hours post-reperfusion.
Main Results:
- No significant differences were observed between WBC and CBC groups in terms of cardiac index, left ventricular stroke work index, or myocardial oxygen consumption.
- Myocardial metabolic and functional recovery showed no significant variations between the two groups.
- The incidence of myocardial infarction, low cardiac output syndrome, and mortality were similar in both WBC and CBC cohorts.
Conclusions:
- Both warm blood cardioplegia (WBC) and cold blood cardioplegia (CBC) provide comparable myocardial protection during coronary artery bypass surgery.
- The choice between WBC and CBC may not significantly impact immediate myocardial recovery or clinical outcomes.
- Further research could explore long-term outcomes and specific patient subgroups for each technique.
Abstract:
Forty patients were randomized to receive antegrade multidose warm (WBC) or cold blood cardioplegia (CBC) during coronary artery bypass. Cardioplegia was infused at a predetermined dose every 10 min during cardioplegia arrest and core temperature was maintained at 37 degrees C in both groups during extracorporeal circulation. Patient profiles were similar in the two groups. Cardiac index, left ventricular stroke work index, and myocardial oxygen consumption were measured before bypass and during the first 7 h of reperfusion. There was no significant difference in myocardial metabolic and function recovery, the incidence of myocardial infarction, low cardiac output or death. Our data suggests that similar protection is provided with the two techniques of myocardial protection.