| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1995;60:819-823
© 1995 The Society of Thoracic Surgeons
Thoracic and Cardiovascular Division, Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia
Abstract
Background. Advances in myocardial protection have been instrumental in making cardiac surgery safer. Debate exists over the optimal medium and the optimal temperature for cardioplegia. Currently blood cardioplegia is preferred over crystalloid; the optimal temperature, however, remains controversial.
Methods. Both warm and cold blood cardioplegia use potassium-induced electromechanical arrest, thereby reducing oxygen consumption by 90% in the working heart. Hypothermic blood cardioplegia given every 15 to 30 minutes provides a bloodless operative field and reduces oxygen consumption an additional 5% to 20%. Continuous warm cardioplegia avoids the deleterious effects of hypothermic ischemia and minimizes reperfusion injury. Perfusion is often interrupted for 5 to 10 minutes to allow adequate visualization of the operative site. Both warm and cold cardioplegia can be given either antegrade or retrograde.
Results. Retrospective studies from Toronto support the safety and efficacy of warm cardioplegia. Two large prospective, randomized trials of warm cardioplegia versus intermittent cold blood or cold crystalloid cardioplegia demonstrated equally low incidences of death, perioperative myocardial infarction, and need of intraaortic balloon pump support.
Conclusions. Warm blood cardioplegia represents the latest development in myocardial protection. Preliminary studies support its efficacy. Additional studies are needed to determine the ideal route of delivery and to identify any risks associated with the inherent warm cardiopulmonary bypass required.
This article has been cited by other articles:
|
|
 |
|
  V. Venugopal, A. Ludman, D. M. Yellon, and D. J. Hausenloy 'Conditioning' the heart during surgery Eur. J. Cardiothorac. Surg., June 1, 2009; 35(6): 977 - 987. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Wang, H. Liu, B. Xiang, G. Li, M. Gruwel, M. Jackson, B. Tomanek, T. A. Salerno, R. Deslauriers, and G. Tian Keeping the heart empty and beating improves preservation of hypertrophied hearts for valve surgery J. Thorac. Cardiovasc. Surg., December 1, 2006; 132(6): 1314 - 1320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. Scarabelli, E. Pasini, G. Ferrari, M. Ferrari, A. Stephanou, K. Lawrence, P. Townsend, C. Chen-Scarabelli, G. Gitti, L. Saravolatz, et al. Warm blood cardioplegic arrest induces mitochondrial-mediated cardiomyocyte apoptosis associated with increased urocortin expression in viable cells J. Thorac. Cardiovasc. Surg., September 1, 2004; 128(3): 364 - 371. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Matsumoto, G. Watanabe, M. Endo, H. Sasaki, F. Kasashima, and I. Kosugi Efficacy and safety of on-pump beating heart surgery for valvular disease Ann. Thorac. Surg., September 1, 2002; 74(3): 678 - 683. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Ascione, M. Caputo, W.J. Gomes, A.A. Lotto, A.J. Bryan, G.D. Angelini, and M.-S. Suleiman Myocardial injury in hypertrophic hearts of patients undergoing aortic valve surgery using cold or warm blood cardioplegia Eur. J. Cardiothorac. Surg., March 1, 2002; 21(3): 440 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Weman, P. J. Karhunen, A. Penttila, A. A. Jarvinen, and U.-S. Salminen Reperfusion injury associated with one-fourth of deaths after coronary artery bypass grafting Ann. Thorac. Surg., September 1, 2000; 70(3): 807 - 812. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Minatoya, H. Okabayashi, I. Shimada, A. Tanabe, T. Nishina, K. Nandate, and M. Kunihiro Intermittent antegrade warm blood cardioplegia for CABG: extended interval of cardioplegia Ann. Thorac. Surg., January 1, 2000; 69(1): 74 - 76. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Caputo, R. Ascione, G. D. Angelini, M-S. Suleiman, and A. J. Bryan The end of the cold era: from intermittent cold to intermittent warm blood cardioplegia Eur. J. Cardiothorac. Surg., November 1, 1999; 14(5): 467 - 475. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M.F. Elwatidy, M. A. Fadalah, E. A. Bukhari, K. A. Aljubair, A. Syed, A. K. Ashmeg, and M. R. Alfagih Antegrade crystalloid cardioplegia vs antegrade/retrograde cold and tepid blood cardioplegia in CABG Ann. Thorac. Surg., August 1, 1999; 68(2): 447 - 453. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Cook Changing Temperature Management for Cardiopulmonary Bypass Anesth. Analg., June 1, 1999; 88(6): 1254 - 1254. [Full Text] [PDF]
|
|
|
|
|
|
F. P. Tritto, J. Inserte, D. Garcia-Dorado, M. Ruiz-Meana, and J. Soler-Soler Sodium/Hydrogen Exchanger Inhibition Reduces Myocardial Reperfusion Edema After Normothermic Cardioplegia J. Thorac. Cardiovasc. Surg., March 1, 1998; 115(3): 709 - 715. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Rivetti and S. M. A. Gandra Initial Experience Using an Intraluminal Shunt During Revascularization of the Beating Heart Ann. Thorac. Surg., June 1, 1997; 63(6): 1742 - 1747. [Abstract] [Full Text]
|
|
|
|
 |
|
 D. D. Belke, L. C. H. Wang, and G. D. Lopaschuk Effects of hypothermia on energy metabolism in rat and Richardson's ground squirrel hearts J Appl Physiol, April 1, 1997; 82(4): 1210 - 1218. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
