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The Annals of Thoracic Surgery, Vol 56, 1020-1028, Copyright © 1993 by The Society of Thoracic Surgeons
TM Yau, JS Ikonomidis, RD Weisel, DA Mickle, N Hayashida, J Ivanov, S Carson, MK Mohabeer and LC Tumiati
One hundred seven patients undergoing coronary artery bypass grafting were
randomized to receive warm antegrade (n = 21), warm retrograde (n = 22),
cold antegrade (n = 20), cold retrograde (n = 22), or intermittent cold
antegrade (n = 22) blood cardioplegia. Myocardial oxygen consumption and
lactate production, adenine nucleotides, and adenine nucleotide degradation
products were measured during the operation, and creatine kinase-MB release
was assessed postoperatively. Warm cardioplegia resulted in greater
myocardial lactate production than cold cardioplegia (p = 0.048).
Retrograde cardioplegia was associated with greater lactate production than
antegrade cardioplegia (p = 0.015). Adenosine triphosphate depletion was
similar among groups. However, poorly diffusible metabolites of adenosine
triphosphate accumulated to the greatest extent in the intermittent cold
group. Levels of hypoxanthine were highest after warm retrograde
cardioplegia. Operative mortality and morbidity were low and were not
different among groups. In summary, none of the five techniques of
cardioplegia evaluated in this study was able to completely prevent
myocardial ischemia. Anaerobic lactate production was minimized with cold
cardioplegia and with antegrade cardioplegic delivery. Hypothermia may have
impaired regeneration of adenosine triphosphate, however, particularly in
association with inadequate or intermittent cardioplegic flow.
ARTICLES
Which techniques of cardioplegia prevent ischemia?
Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada.
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