The Annals of Thoracic Surgery, Vol 41, 511-514, Copyright © 1986 by The Society of Thoracic Surgeons
Cold potassium cardioplegia versus topical hypothermia and intermittent aortic occlusion for myocardial protection during coronary artery surgery: a randomized clinical study
HR Baur, TA Peterson, WG Yasmineh and FL Gobel
The effect of two different myocardial preservation techniques on
perioperative myocardial necrosis during coronary artery bypass surgery was
assessed by serial myocardial creatine kinase determinations in 100
consecutive patients operated on by the same surgeon. Topical hypothermia
with cold potassium cardioplegia was used randomly in 50 patients (group
1), and topical hypothermia with local interruption of the coronary
circulation was used in the other 50 patients (group 2). Myocardial
creatine kinase was measured by column chromatography every 6 hours for 36
hours after surgery. There was no significant difference between the two
groups in terms of age, sex, functional class, extent of coronary artery
disease, number of bypassed arteries, ejection fraction, or cardiopulmonary
bypass time. Myocardial creatine kinase release (mean +/- standard error of
the mean) was 193 +/- 33 IU/L X hours in group 1 patients operated on with
cardioplegia and 210 +/- 31 IU/L X hours in group 2 patients operated on
with topical hypothermia (p greater than 0.5). Myocardial creatine kinase
peaks were 9.2 +/- 1.9 IU/L and 10.0 +/- 1.6 IU/L, respectively (p greater
than 0.5). Perioperative myocardial infarction, as defined by serum enzyme
activity and electrocardiographic criteria, occurred in 4 patients in group
1 and 3 patients in group 2. Thus, the addition of cardioplegia to topical
hypothermia, although perhaps offering technical advantages, does not
appear to improve myocardial protection over topical hypothermia with local
interruption of the coronary circulation during coronary artery bypass
surgery.
