HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John C. Mullen Stephen E. Fremes Richard D. Weisel George T. Christakis Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mullen, J. C. Articles by McLaughlin, P. R. Search for Related Content PubMed PubMed Citation Articles by Mullen, J. C. Articles by McLaughlin, P. R.

Ann Thorac Surg 1987;43:17-24
© 1987 The Society of Thoracic Surgeons

---

Articles

Right Ventricular Function: A Comparison Between Blood and Crystalloid Cardioplegia

From the Divisions of Cardiovascular Surgery and Nuclear Cardiology, the Toronto General Hospital and the University of Toronto, Toronto, Ont, Canada

^* Address reprint requests to Dr. Weisel, Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth St, Eaton North 13–224, Toronto, Ont, Canada M5G 2C4

Blood cardioplegia resulted in better left ventricular (LV) function than crystalloid cardioplegia after elective coronary artery bypass operations, However, most methods of cardioplegic delivery may not adequately cool and protect the right ventricle, and right ventricular (RV) dysfunction may limit hemodynamic recovery. Therefore, RV and LV temperatures were measured intraoperatively and RV and LV function were evaluated postoperatively in 80 patients with double-vessel or triple-vessel coronary artery disease who were randomized to receive either blood cardioplegia or crystalloid cardioplegia. Myocardial performance, systolic function, and diastolic function were assessed with nuclear ventriculography by evaluating the response to volume loading. Preoperatively the groups were similar. Intraoperatively, blood cardioplegia resulted in significantly warmer LV and RV temperatures (left ventricle: 15.5° ± 0.2°C with blood cardioplegia and 12.6° ± 0.3°C with crystalloid cardioplegia [p < .0001]; right ventricle: 18.3° ± 0.3°C with blood cardioplegia and 15.1° ± 0.3°C with crystalloid cardioplegia [p < .0001]). Postoperatively, blood cardioplegia resulted in better LV performance (higher LV stroke work index at a similar LV end-diastolic volume index [EDVI]) (p = .01), better LV systolic function (similar systolic blood pressures at smaller LV end-systolic volume indexes [EDVI]), (p = .04), and improved LV diastolic function (lower left atrial pressures at similar LVEDVIs) (p = .03). For the right ventricle, performance and diastolic function were similar after blood and crystalloid cardioplegia, but RV systolic function was better (p = .03) with crystalloid cardioplegia (systolic pulmonary artery pressures were higher, 29.8 ± 1.8 mm Hg with crystalloid cardioplegia and 25.0 ± 0.8 mm Hg with blood cardioplegia at similar RVESVIs, 62 ± 4 mL/m² for crystalloid cardioplegia and 60 ± 6 ml/m² with blood cardioplegia).

Blood cardioplegia provided excellent protection for the left ventricle but crystalloid cardioplegia produced colder RV temperatures and better postoperative RV function.

This article has been cited by other articles:

				S. Jacob, A. Kallikourdis, F. Sellke, and J. Dunning Is blood cardioplegia superior to crystalloid cardioplegia? Interact CardioVasc Thorac Surg, June 1, 2008; 7(3): 491 - 498. [Abstract] [Full Text] [PDF]

				M. J. Davidson Can the Off-Pump Coronary Artery Bypass Debate Shed Light on Postoperative Right Heart Dysfunction? Circulation, April 29, 2008; 117(17): 2181 - 2183. [Full Text] [PDF]

				N. D. Desai and G. T. Christakis Bioprosthetic Aortic Valve Replacement: Stented Pericardial and Porcine Valves Card. Surg. Adult, January 1, 2008; 3(2008): 857 - 894. [Full Text]

				V. Guru, J. Omura, A. A. Alghamdi, R. Weisel, and S. E. Fremes Is Blood Superior to Crystalloid Cardioplegia?: A Meta-Analysis of Randomized Clinical Trials Circulation, July 4, 2006; 114(1_suppl): I-331 - I-338. [Abstract] [Full Text] [PDF]

				N. D. Desai and G. T. Christakis Stented Mechanical/Bioprosthetic Aortic Valve Replacement Card. Surg. Adult, January 1, 2003; 2(2003): 825 - 856. [Full Text]

				Z.-K. Wu, M. R. Tarkka, E. Pehkonen, L. Kaukinen, E. L. Honkonen, and S. Kaukinen Beneficial effects of ischemic preconditioning on right ventricular function after coronary artery bypass grafting Ann. Thorac. Surg., November 1, 2000; 70(5): 1551 - 1557. [Abstract] [Full Text] [PDF]

				M. F. Ibrahim, G. E. Venn, C. P. Young, and D. J. Chambers A clinical comparative study between crystalloid and blood-based St Thomas' hospital cardioplegic solution Eur J Cardiothorac Surg, January 1, 1999; 15(1): 75 - 83. [Abstract] [Full Text] [PDF]

				Y. A. G. Louagie, E. Gonzalez, J. Jamart, B. Malhomme, S. Broka, M. Buche, P. M. Eucher, and J.-C. Schoevaerdts Assessment of Continuous Cold Blood Cardioplegia in Coronary Artery Bypass Grafting Ann. Thorac. Surg., March 1, 1997; 63(3): 689 - 696. [Abstract] [Full Text]

				G. T. Christakis, K. J. Buth, R. D. Weisel, V. Rao, L. Joy, S. E. Fremes, and B. S. Goldman Randomized Study of Right Ventricular Function With Intermittent Warm or Cold Cardioplegia Ann. Thorac. Surg., January 1, 1996; 61(1): 128 - 134. [Abstract] [Full Text]

				B. S. Allen, J. W. Winkelmann, H. Hanafy, R. S. Hartz, K. S. Bolling, J. Ham, and S. Feinstein Retrograde cardioplegia does not adequately perfuse the right ventricle J. Thorac. Cardiovasc. Surg., June 1, 1995; 109(6): 1116 - 1126. [Abstract] [Full Text]

				J. R. Anderson, M. Hossein-Nia, P. Kallis, M. Pye, D. W. Holt, A. J. Murday, and T. Treasure Comparison of two strategies for myocardial management during coronary artery operations Ann. Thorac. Surg., September 1, 1994; 58(3): 768 - 772. [Abstract] [PDF]

				Y. A. G. Louagie, E. Collard, M. Gonzalez, A. Gruslin, J. Jamart, V. Delire, A. Mayne, M. Buche, and J.-C. Schoevaerdts Initial experience with low-potassium cold blood cardioplegia: A clinical comparative study Ann. Thorac. Surg., April 1, 1992; 53(4): 628 - 634. [Abstract] [PDF]

				H. B. Barner Blood cardioplegia: A review and comparison with crystalloid cardioplegia Ann. Thorac. Surg., December 1, 1991; 52(6): 1354 - 1367. [Abstract] [PDF]

				A. Mangschau Akinetic versus dyskinetic left ventricular aneurysms diagnosed by gated scintigraphy: Difference in surgical outcome Ann. Thorac. Surg., May 1, 1989; 47(5): 746 - 751. [Abstract] [PDF]

				A. Mangschau, O. Geiran, K. Rootwelt, B. Laake, and K. Forfang Impairment in Right Ventricular Performance after Left Ventricular Aneurysm Surgery Ann. Thorac. Surg., November 1, 1988; 46(5): 542 - 548. [Abstract] [PDF]

				J. T. Diehl, E. J. Eichhorn, M. A. Konstam, D. D. Payne, A. R. Dresdale, R. M. Bojar, H. Rastegar, J. J. Stetz, D. N. Salem, R. J. Connolly, et al. Efficacy of Retrograde Coronary Sinus Cardioplegia in Patients Undergoing Myocardial Revascularization: A Prospective Randomized Trial Ann. Thorac. Surg., June 1, 1988; 45(6): 595 - 602. [Abstract] [PDF]

				G. A. Patterson, J. D. Cooper, B. Goldman, R. D. Weisel, F. G. Pearson, P. F. Waters, T. R. Todd, H. Scully, M. Goldberg, and R. J. Ginsberg Technique of Successful Clinical Double-Lung Transplantation Ann. Thorac. Surg., June 1, 1988; 45(6): 626 - 633. [Abstract] [PDF]

				J. B. Rich, C. W. Akins, and W. M. Daggett Jr. Right Ventricular Failure Following Cardiopulmonary Bypass: Inadequate Myocardial Protection or Incomplete Revascularization? Ann. Thorac. Surg., June 1, 1988; 45(6): 693 - 694. [PDF]