Document Detail


Does simultaneous antegrade and retrograde cardioplegia improve functional recovery and myocardial homeostasis?
MedLine Citation:
PMID:  11599829     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The purpose of our research was to evaluate the functional recovery and homeostasis of myocardium during simultaneous continuous retrograde and antegrade cardioplegia versus continuous retrograde cardioplegia. METHODS: Forty patients who underwent elective coronary artery bypass grafting (CABG) were prospectively assigned to two clinically matched groups and analyzed in respect to cardioplegia protocol. Group I consisted of 24 patients who received continuous retrograde blood cardioplegia; Group II consisted of 16 patients who received simultaneous continuous ante- and retrograde cardioplegia. Hydrogen ion release, carbon dioxide, lactate concentration oxygen content, and oxygen extraction were measured from coronary sinus effluent and from the arterial line before and after cross-clamping of the aorta. Median changes of these parameters were reported. Cardiac output was measured and left and right ventricle stroke works were calculated. Incidence of low cardiac output, ventricular fibrillation, raised cardiac enzymes, and ischemic changes on electrocardiogram (ECG) were noted. RESULTS: In the simultaneous group, oxygen content and oxygen extraction recovered well after cross-clamping. The same parameters did not recover to the same extent in the retrograde group. These changes were notable between groups. Hydrogen ion, carbon dioxide, and lactate releases were comparable between groups. Trend toward better recovery of left ventricle stroke work index was encountered in the simultaneous group. CONCLUSIONS: Viability of myocardium measured with oxygen utilization and functional recovery is better preserved with simultaneous antegrade and retrograde cardioplegia. However, there is no difference in anaerobic metabolism markers. Thus simultaneous ante- and retrograde cardioplegia is probably advantageous over retrograde alone.
Authors:
M J Jasinski; S Wos; Z Kadziola; I A Wenzel-Jasinska; T J Spyt
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of cardiac surgery     Volume:  15     ISSN:  0886-0440     ISO Abbreviation:  J Card Surg     Publication Date:    2000 Sep-Oct
Date Detail:
Created Date:  2001-10-15     Completed Date:  2001-11-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8908809     Medline TA:  J Card Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  354-61     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, United Kingdom. marek.jasinski@glenfield-tr.trent.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aorta / surgery
Carbon Dioxide / blood
Cardiopulmonary Bypass
Coronary Artery Bypass
Coronary Disease / metabolism*,  surgery*
Female
Heart Arrest, Induced*
Hemodynamics / physiology
Homeostasis / physiology*
Humans
Hydrogen-Ion Concentration
Lactic Acid / blood
Male
Middle Aged
Myocardium / metabolism*
Oxygen / blood
Prospective Studies
Recovery of Function / physiology*
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide; 50-21-5/Lactic Acid; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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