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[Is crystalloid cardioplegia still a valid technique for myocardial myocardial protection?]
A Ortiz de Salazar1, J Zuazo, J A González
1Servicio de Cirugía Cardíaca, Hospital de Basurto, Vizcaya.
Insights
Crystalloid cardioplegia is a safe and effective method for myocardial protection during cardiac surgery, especially for patients with normal left ventricular function. This study found no significant differences in major outcomes compared to blood cardioplegia.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Myocardial protection during cardiac surgery is crucial.
- Crystalloid and blood cardioplegic solutions are used for this purpose.
- Blood cardioplegia is widely adopted due to perceived superior protection.
Purpose of the Study:
- To evaluate the efficacy of crystalloid cardioplegia compared to blood cardioplegia.
- To assess if crystalloid cardioplegia remains a useful myocardial protection technique.
Main Methods:
- Retrospective study comparing 40 patients receiving crystalloid cardioplegia (Group A) and 72 patients receiving blood cardioplegia (Group B).
- Patients underwent cardiac surgery between March 1994 and March 1995.
- Clinical and surgical variables, as well as postoperative outcomes, were analyzed.
Main Results:
- No significant differences in clinical or surgical characteristics between groups.
- Higher mean graft number in Group B (3.5 vs 2.5, p < 0.01).
- Higher incidence of supraventricular arrhythmias in Group A (20% vs 5%, p < 0.05) and lower lactate dehydrogenase levels in Group A (472 vs 572 mu/l, p < 0.05).
Conclusions:
- Crystalloid cardioplegia is a valid and effective myocardial protection strategy.
- It is particularly suitable for cardiac patients with preserved left ventricular systolic function.
- The study supports the continued use of crystalloid cardioplegia in specific patient populations.
Objectives:
The routine use of a cardioplegic solution for myocardial protection during the ischemic phase of cardiac surgery represents a great therapeutic advance. Two cardioplegic solutions are currently in use: crystalloid and blood solutions. As blood cardioplegia has been shown to offer superior myocardial protection, its use at present is widespread. We did a retrospective study to assess whether crystalloid cardioplegia might nevertheless continue to be useful.
Patients And Methods:
Forty patients with heart disease underwent surgery between March 1994 and March 1995, with the use of crystalloid cardioplegia (group A). Blood cardioplegia was used in 72 patients during the same period (group B).
Results:
There were no significant differences in clinical (age, arterial hypertension, diabetes, chronic bronchial disease, severity of angina, severity of heart disease) or surgical (emergency, percent use of the internal thoracic artery, duration of extracorporeal circulation) variables. The percentage of patients with low ejection fraction was higher in group B as a result of preoperative selection. The mean number of grafts was higher in group B than in group A (3.5% and 2.5, respectively) (p < 0.01). Postoperative results (use of inotropics, counterpulsation balloon, creatine phosphokinase, perioperative myocardial infarction or hospital mortality) were not significantly different. The percent of supraventricular arrhythmias after surgery was higher in group A than in group B (20% and 5%, respectively) (p < 0.05) and lactic dehydrogenase level was lower in group A than in group B (472 and 572 mu/l, respectively) (p < 0.05).
Conclusions:
We believe that crystalloid cardioplegia continues to be a valid and effective myocardial protection technique in heart patients with preserved left ventricular systolic function.