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Ann Thorac Surg 1998;65:615-621
© 1998 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Minimally Diluted Tepid Blood Cardioplegia

Nobuhiko Hayashida, MD, Tadashi Isomura, MD, Tohru Sato, MD, Hiroshi Maruyama, MD, Takaya Higashi, MD, Kouichi Arinaga, MD, Shigeaki Aoyagi, MD

Second Department of Surgery, Kurume University, Fukuoka, Japan

Accepted for publication August 19, 1997.

Dr Hayashida, Second Department of Surgery, Kurume University, 67 Asahi-machi, Kurume, Fukuoka 830, Japan.

Background. To evaluate the effects of minimally diluted tepid blood cardioplegia, a prospective, randomized study was undertaken.

Methods. Thirty-seven patients undergoing isolated primary coronary artery bypass grafting were randomized to receive standard 4:1 diluted tepid blood cardioplegia (4:1 group, n = 18) or minimally diluted tepid blood cardioplegia (Mini group, n = 19). Cardioplegic solution was delivered in an intermittent antegrade fashion in both groups. Myocardial oxygen and lactate metabolism, release of the MB isoenzyme of creatine kinase and thiobarbituric acid reactive substances, and cardiac function were measured during and after the operation.

Results. Myocardial oxygen consumption was significantly greater and lactate release was significantly lower in the Mini group than in the 4:1 group during cardioplegia. Minimally diluted blood cardioplegia resulted in more prompt resumption of lactate extraction, lower levels of release of the myocardial-specific isoenzyme of creatine kinase and thiobarbituric acid reactive substances during reperfusion, and better postoperative left ventricular function compared with the standard 4:1 cardioplegia.

Conclusions. Minimally diluted tepid blood cardioplegia may provide superior myocardial protection than the standard 4:1 dilution technique by optimizing the aerobic environment through an increase in oxygen supply during intermittent cardioplegia.




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