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Ann Thorac Surg 2004;77:664-671
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

Continuous cold blood cardioplegia improves myocardial protection: a prospective randomized study

^a Cardiovascular and Thoracic Unit, Mont Yvoir, Belgium
^b Biostatistics, Mont Yvoir, Belgium
^c Intensive Care Unit, Mont Yvoir, Belgium
^d Anesthesiology, Mont Yvoir, Belgium
^e Laboratory of Clinical Biology, Mont Yvoir, Belgium
^f Perfusion Team, University Clinics of Mont Godinne, Université Catholique de Louvain, Mont Yvoir, Belgium

Accepted for publication August 6, 2003.

^* Address reprint requests to Dr Louagie, Cardiovascular and Thoracic Surgery, University Clinics of Mont Godinne, 1 av Therasse, B-5530 Mont Yvoir, Belgium
e-mail: louagie{at}chir.ucl.ac.be

BACKGROUND: To assess the influence on myocardial protection of the rate of infusion (continuous vs intermittent) of cold blood cardioplegia administered retrogradely during prolonged aortic cross-clamping. The end-points were ventricular performance and biochemical markers of ischemia.

METHODS: Seventy patients undergoing myocardial revascularization for three-vessel disease were prospectively randomized to receive intermittent or continuous retrograde cold blood cardioplegia. Hemodynamic measurements were obtained using a rapid-response thermodilution catheter and included right ventricular ejection fraction, cardiac output, left and right ventricular stroke work index, and systemic and pulmonary vascular resistance. Blood samples were obtained from the coronary sinus before cross-clamp application and immediately after cross-clamp removal for determinations of lactate and hypoxanthine.

RESULTS: The left ventricular stroke work index trend was significantly superior (p = 0.038) by repeated-measures analysis in continuous cardioplegia. Other hemodynamic measurements revealed a similar trend. The need for postoperative inotropic drugs support was reduced in continuous cardioplegia. The release of lactate in the coronary sinus after unclamping was 2.30 ± 0.12 mmol/L after intermittent cardioplegia and 1.97 ± 0.09 mmol/L after continuous cardioplegia (p = 0.036). The release of hypoxanthine was 20.47 ± 2.74 µmol/L in intermittent cardioplegia and 11.77 ± 0.69 µmol/L in continuous cardioplegia (p = 0.002).

CONCLUSIONS: Continuous cold blood cardioplegia results in improved ventricular performance and reduced myocardial ischemia in comparison with intermittent administration.

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