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Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
Online ISSN 1827-191X
Hayashi Y. 1, Ohtani M. 1, Sawa Y. 2, Hiraishi T. 1, Akedo H. 1, Kobayashi Y. 1, Nakamura T. 1, Matsuda H. 2
1 Unit of Cardiovascular Surgery National Hospital Organization Osaka Minami Medical Center Kawachinagano City, Osaka, Japan
2 Department of Surgery Course of Interventional Medicine (E1) Osaka University Graduate School of Medicine Suita City, Osaka, Japan
Aim. The most effective delivery of blood cardioplegia (BCP) remains controversial, and a combination of initial continuous and intermittent bolus BCP seems to compensate each demerit. However, a large amount of crystalloid solution is infused into the myocardium in this method, which may nullify the advantages of BCP. We examined the hypothesis that minimally-diluted BCP resolves this issue and provides superior myocardial protective effects.
Methods. Seventy patients undergoing elective coronary revascularization between 1997-2001 (M:F=55:15, mean age 67.6±7.5 years) were randomly allocated into one of 2 groups: Group C (n=35) was given the standard 4:1-diluted blood-crystalloid BCP, and Group M (n=35) was given minimally-diluted BCP supplemented with potassium-chloride and magnesium-sulfate. The BCP temperature was maintained at 30°C. Cardioplegic arrest was induced with 2 minutes of initial antegrade BCP infusion, followed by continuous retrograde BCP infusion. Intermittent antegrade BCP was infused every 30 minutes for 2 minutes.
Results. The time required for achieving cardioplegic arrest was significantly shorter in Group M (47.5±16.3 vs 62.5±17.6 s, p<0.0001) and the number of patients showing spontaneous heart-beat recovery after aortic unclamping was significantly larger in Group M (28 vs 15, p=0.0029). The number of patients suffering from atrial fibrillation during the postoperative period was significantly smaller in Group M (3 vs 11, p=0.034). The total amount of crystalloid solution infused as cardioplegia was significantly smaller in Group M (62.8±22.3 vs 733.6±382.6 mL, p<0.0001). Postoperative maximum dopamine dose (3.57±2.46 vs 5.44±2.23 μg/kg/min, p=0.0014) and peak creatine kinase-MB (19.5±8.5 vs 25.8±11.9 IU/L, p=0.0128) were significantly lower in Group M. The number of patients showing paradoxical movement of the ventricular septum by early postoperative echocardiography was significantly smaller in Group M (9 vs 24, p<0.0007).
Conclusion. These results demonstrate that initial continuous and intermittent bolus administration of minimally-diluted BCP supplemented with potassium and magnesium can be a simple, reliable and effective technique of intraoperative myocardial protection.