ORIGINAL ARTICLES  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 2000 October;41(5):695-702

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Long term left ventricular systolic function assessment following CABG. A prospective, randomised study. Blood versus cristalloid cardioplegia

Gasior Z., Krejca M., Szmagala P., Bochenek A.

From the 1st Cardiac Surgery Department *1st Cardiology Department Silesian School of Medicine, Katowice, Poland

Back­ground. In an ­effort to ­define the ­role of ­blood car­di­o­plegia deliv­ered in ante­grade/ret­ro­gade ­fashion in ­patients ­with ­either ­good or ­poor ­left ven­tric­ular func­tion under­going elec­tive cor­o­nary ­artery ­bypass sur­gery, we ­initiated a pros­pec­tive ran­dom­ised ­study in ­which post­op­er­a­tive hemo­dy­namics ­besides clin­ical ­data ­were com­pared in ­patients admin­is­tered ante­grade/ret­ro­grade crys­tal­loid car­di­o­plegia.
­Methods. To com­pare the effi­ciency of two ­methods of myo­car­dial pro­tec­tion — ­cold crys­tal­loid ­ante/­retro car­di­o­plegia and ­cold ­blood ante/­retro car­di­o­plegia in two ­groups of ­patients ­with ­high and low ­LVEF — we ran­dom­ised 122 ­patients for ­CABG. The poten­tial improve­ment in ­left ven­tric­ular sys­tolic func­tion ­assessed by ech­o­car­di­og­raphy and the ­same clin­ical ­data ­were the end ­points of the ­study. ­Patients ­were ­divided ­into ­group I (47 patients, ­LVEF <40%) and ­group II (75 patients, ­LVEF >40%). Path­o­logic ante­ce­dents and pre­op­er­a­tive clin­ical con­di­tions ­were sim­ilar in ­both ran­dom­ised sub­groups Ia, IIa (crys­tal­loid car­di­o­plegia) and sub­groups Ib, IIb (blood car­di­o­plegia). The fol­lowing param­e­ters ­were meas­ured: ­left ­atrium diam­eter (LA), ­left ven­tric­ular end dia­stolic diam­eter (­LVEDD), ­left ven­tric­ular end sys­tolic diam­eter (­LVESD), ­left ven­tric­ular ejec­tion frac­tion (­LVEF), ­left ven­tric­ular ­wall ­motion ­score ­index (­WMSI), and ­area asy­nergy (AA). All ­patients under­went ech­o­car­di­og­raphy: A - ­prior the ­CABG, B - 2-6 ­weeks ­postoperatively, C - 3 ­months ­postoperatively, D - 6 ­months ­postoperatively, E - 1 ­year ­postoperatively.
­Results. The ­results of clin­ical assess­ment in ­both ­groups ­showed improve­ment of ­quality of ­life. The con­stant improve­ment of ­LVEF and ­WMSI was ­observed in ­group I in con­trast to ­group II. ­There ­were no sig­nif­i­cant dif­fer­ences in post­op­er­a­tive ­left ven­tric­ular sys­tolic func­tion ­between sub­groups Ia and Ib or IIa and IIb.
Con­clu­sions. The use of ­blood car­di­o­plegia, ­instead of crys­tal­loid car­di­o­plegia, ­when ­used in the ­ante/ret­ro­grade ­fashion ­during ­CABG has no influ­ence on post­op­er­a­tive ­left ven­tric­ular sys­tolic func­tion. The improve­ment in ­left ven­tric­ular sys­tolic func­tion fol­lowing ­CABG is ­greater in ­patients ­with low ­LVEF in con­trast to ­patients ­with ­high ­LVEF.