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The Journal of Cardiovascular Surgery 2001 April;42(2):193-6

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

A comparison of ischemic preconditioning versus terminal warm cardioplegia with controlled reperfusion in open heart operation

Luo W. J., Chen S. X., Jian H. H., Xu L. M.

From the Department of Cardiothoracic Surgery Xiang Ya Hospital, Hunan Medical University Hunan, Changsha, P. R. China


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Back­ground. The pur­pose of ­this ­study was to eval­uate the ­effects of ­three dif­ferent ­methods of car­di­op­ro­tec­tion in ­patients under­going ­valve replace­ment.
­Methods. ­Ninety ­patients under­going elec­tive ­valve replace­ment ­were ran­domly ­divided ­into ­three ­groups. In ­group 1 (n=30), the ­patients ­received inter­mit­tent ­cold ­blood car­di­o­plegia. In ­group 2 (n=30) ­they ­received ter­minal ­warm car­di­o­plegia and con­trolled reper­fu­sion, and in ­group 3 (n=30), the ­patients ­received two ­cycles of ­ischemia (2 min­utes) and reper­fu­sion (3 min­utes) ­before ­heart ­arrest ­induced by ­cold ­blood car­di­o­plegia. The param­e­ters of car­diac func­tion, crea­tine ­kinase MB, and clin­ical out­comes ­were ­recorded to ­assess the ­effects of experi­ment.
­Results. The ­major pre­op­er­a­tive and intra­op­er­a­tive var­i­ables are com­par­able ­within the ­three ­groups. The ­number of ­patients ­requiring the sup­port of ­inotropic ­agents was 70% (21/30), 33% (11/30) and 40% (12/30) in ­group 1, 2 and 3, respec­tively (p<0.05). The ­doses of ­inotropic ­agent in ­groups 2 and 3, ­were sig­nif­i­cantly ­lower ­than in ­group 1 (1.5±0.3 and 1.8±0.4 ­versus 4.5±0.8 μg.kg.min-1, p<0.01) ­during the ­first 24 ­hours ­after oper­a­tion. Two ­deaths (30 day-hos­pital mor­tality) ­occurred, one in ­group 1 and one in ­group 2. The car­diac ­index at 2 ­hours ­after ­bypass dis­con­tin­uing ­were 2.2±0.04, 3.0±0.1 and 2.8±0.05 L/m2 in ­group 1, 2 and 3, respec­tively (p<0.01). The ­left ven­tric­ular ­stroke ­work ­index ­were 24.8±1.3, 34.5±1.6 and 31.6±1.2 g/m.m2 in ­group 1, 2, 3, respec­tively (p<0.01). The ­release of CK-MB in ­group 2 and 3 ­were ­lower ­than in ­group 1 (68±7, 81±9 ­versus 116±10 IU/L, p<0.01).
Con­clu­sions. Ter­minal ­warm car­di­o­plegia ­with con­trolled ­aortic ­root reper­fu­sion and ­ischemic pre­con­di­tioning ­equally ­improve car­diac func­tion and ­reduce the require­ment of ­inotropic ­agents in ­patients under­going ­valve replace­ment.

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