Home > Riviste > The Journal of Cardiovascular Surgery > Fascicoli precedenti > The Journal of Cardiovascular Surgery 2005 Febbraio;46(1) > The Journal of Cardiovascular Surgery 2005 Febbraio;46(1):61-8

ULTIMO FASCICOLO
 

ARTICLE TOOLS

Estratti

THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632


eTOC

 

ORIGINAL ARTICLES  CARDIAC SECTION


The Journal of Cardiovascular Surgery 2005 Febbraio;46(1):61-8

lingua: Inglese

Initial, continuous and intermittent bolus cardioplegia administration: Efficacy of potassium-chloride and magnesium-sulfate as minimal additives for minimally-diluted blood cardioplegia

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


PDF  


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.

inizio pagina

Publication History

Per citare questo articolo

Corresponding author e-mail