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Prospective, randomized trial comparing blood and oxygenated crystalloid cardioplegia in reoperative coronary artery
J S Shanewise1, A S Kosinski, J A Coto
1Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA.
Insights
Oxygenated blood and crystalloid cardioplegia are equally effective for preserving heart muscle during reoperative coronary artery bypass grafting. Transesophageal echocardiography showed no significant differences in left ventricular wall motion between the two methods.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Biomedical Engineering
Background:
- Reoperative coronary artery bypass grafting (CABG) poses significant challenges for myocardial preservation.
- Effective myocardial protection strategies are crucial in complex cardiac surgeries.
Purpose of the Study:
- To compare the efficacy of oxygenated blood cardioplegia versus oxygenated crystalloid cardioplegia.
- To assess myocardial preservation during reoperative CABG using transesophageal echocardiography (TEE).
Main Methods:
- Prospective randomized trial involving 61 patients undergoing reoperative CABG.
- Comparison of oxygenated blood cardioplegia and oxygenated crystalloid cardioplegia via combined antegrade-retrograde delivery.
- TEE assessment of left ventricular regional wall motion before and after cardiopulmonary bypass.
Main Results:
- No significant differences in the change of regional wall motion scores were observed between the blood and crystalloid cardioplegia groups.
- Both cardioplegia solutions demonstrated comparable outcomes in preserving myocardial function.
Conclusions:
- Oxygenated blood and crystalloid cardioplegia are equally effective for myocardial preservation in reoperative CABG.
- The choice between blood and crystalloid cardioplegia may not significantly impact immediate postoperative left ventricular function in this context.
Objectives:
Reoperative coronary artery bypass grafting presents unique challenges for myocardial preservation. The purpose of this study was to compare oxygenated blood cardioplegia with oxygenated crystalloid cardioplegia during reoperative coronary artery bypass grafting using transesophageal echocardiography to assess regional wall motion of the left ventricle before and after cardiopulmonary bypass.
Methods:
Sixty-one patients undergoing reoperative coronary artery bypass grafting were prospectively randomized to receive oxygenated blood cardioplegia or oxygenated crystalloid cardioplegia delivered with a combined antegrade-retrograde technique. Transgastric short axis views of the left ventricle were made with transesophageal echocardiography during the operation before cardiopulmonary bypass and immediately after cardiopulmonary bypass. Regional wall motion was graded by a blinded observer, and before cardiopulmonary bypass scores were compared with after cardiopulmonary bypass scores.
Results:
No significant differences were found in the change in regional wall motion score from before cardiopulmonary bypass to after cardiopulmonary bypass between the blood and crystalloid cardioplegia groups.
Conclusions:
This study found blood and crystalloid cardioplegia to be equally efficacious for myocardial preservation during reoperative coronary artery bypass grafting.
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