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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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

lingua: Inglese

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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