ORIGINAL ARTICLES  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2005 December;46(6):577-81

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Blood warm reperfusion: a necessary adjunct to heart-valve surgery in low-risk patients?

Falcoz P. E. ¹, Kaili D. ¹, Chocron S. ¹, Stoica L. ¹, Toubin G. ², Puyraveau M. ³, Viel J. F. ⁴, Etievent J. P. ¹

¹ Department of Thoracic and Cardiovascular Surgery Hôpital Jean-Minjoz, Besançon, France 2 Department of Pharmacology Hôpital Jean-Minjoz Besançon, France 3 Department of Biostatistics and Epidemiology Faculy of Medicine and Pharmacology, Besançon, France 4 Department of Public Health Hôpital Saint-Jacques, Besançon, France

Aim. The aim of this prospective, randomized study was to determine whether blood warm reperfusion improves myocardial protection provided by cold crystalloid cardioplegia in patients undergoing first-time elective heart-valve surgery, using cardiac troponin I release as the criterion for evaluating the adequacy of myocardial protection.
Methods. Seventy patients with a left ventricular ejection fraction greater than 40% were randomly assigned to 1 of 2 myocardial protection strategies: 1) cold crystalloid cardioplegia with no reperfusion or 2) cold crystalloid cardioplegia followed by 2-minute blood warm reperfusion before aortic unclamping. Cardiac troponin I concentrations were measured in serial venous blood samples drawn immediately prior to cardiopulmonary bypass and after aortic unclamping at 6, 9, 12, and 24 h.
Results. Randomization produced 2 equivalent groups. The total amount of cardiac troponin I released (7.17± 14.8 μg in the crystalloid cardioplegia with no reperfusion group and 5.82±4.66 μg in the crystalloid cardioplegia followed by blood warm reperfusion group) was not different (P>0.2). Cardiac troponin I concentration did not differ for any sample in either of the 2 groups. The total amount of cardiac troponin I released was higher in patients who required inotropic support (9.14 ±16.2 μg) than those who did not (4.73±4.52 μg; P=0.009).
Conclusion. Our study shows that adding blood warm reperfusion to cold crystalloid cardioplegia provides no additional myocardial protection in low-risk patients undergoing heart-valve surgery.