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Ann Thorac Surg 1990;50:771-775
© 1990 The Society of Thoracic Surgeons

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Articles

Myocardial preservation using lidocaine blood cardioplegia

Division of Cardiothoracic Surgery, Department of Surgery, St. Louis University Medical Center and St. Mary's Health Center, St. Louis, Missouri, USA

Accepted for publication July 13, 1990.

^_* Address reprint requests to Dr Fiore, Department of Surgery, St. Louis University Medical Center, 3635 Vista Ave at Grand Blvd, PO Box 15250, St. Louis, MO 63110-0250.

Prevention of ventricular fibrillation after aortic unclamping using lidocaine hydrochloride as an additive to cold potassium blood cardioplegia was studied prospectively in 46 patients undergoing elective myocardial revascularization. Patients were similar with respect to age, ventricular function, severity of coronary artery disease, cross-clamp time, completeness of revascularization, frequency of internal thoracic artery grafting, systemic temperature at the time of cross-clamp removal, and mean infusate volume and temperature. Patients receiving lidocaine blood cardioplegia (group 1, 23 patients) had a significant reduction in the incidence of ventricular fibrillation (22% versus 74%; p < 0.0005) and in the mean number of cardioversion attempts required to defibrillate the heart (0.5 ± 1.3 versus 1.9 ± 0.97; p < 0.0005) after cross-clamp removal compared with controls (group 2, 23 patients). There were no differences between the two groups postoperatively with regard to cardiac enzyme release, hemodynamic measurements, or clinical outcome. Patients receiving lidocaine blood cardioplegia tended to have a lower incidence of new postoperative atrial fibrillation (9% versus 26%). Ventricular function was preserved equally in both groups. We conclude that lidocaine is a safe additive to potassium blood cardioplegia and significantly reduces the incidence of ventricular fibrillation after aortic unclamping.

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