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The Annals of Thoracic Surgery, Vol 58, 41-48, Copyright © 1994 by The Society of Thoracic Surgeons
LC Pelletier, M Carrier, Y Leclerc, R Cartier, E Wesolowska and BC Solymoss
A prospective, randomized study was performed in 200 patients undergoing
coronary artery bypass grafting to compare the myocardial protection
obtained with intermittent antegrade warm versus cold blood cardioplegia.
Preoperative and surgical characteristics of the two cohorts were similar.
Intermittent antegrade infusion of warm blood cardioplegia failed to
achieve sustained electromechanical arrest of the heart in 13%. The only
difference in clinical outcomes was the more frequent spontaneous return to
sinus rhythm after the unclamping of the aorta in the warm group (88%
versus 70%, p = 0.002). Mortality (1% each) and myocardial infarction (2%
and 4%) rates were similar. Rates of increase in serum activity of the
isoenzyme of creatine kinase (CK- MB), CK-MB mass concentration, and
cardiac troponin-T level as well as total release of troponin T were
significantly lower in the warm group, and fewer patients in this group had
a clinically significant increase in serum CK-MB mass (20% versus 39%, p =
0.005) and troponin T (20% versus 56%, p = 0.00001). Thus, intermittent
antegrade warm blood cardioplegia is appropriate and clinically safe; the
lower release of biochemical markers of myocardial damage suggests improved
protection during first-time coronary artery bypass grafting.
ARTICLES
Intermittent antegrade warm versus cold blood cardioplegia: a prospective, randomized study
Department of Surgery and Laboratory Medicine, Montreal Heart Institute, Quebec, Canada.
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