Document Detail


Normothermic versus mild hypothermic retrograde blood cardioplegia: a prospective, randomized study.
MedLine Citation:
PMID:  7574954     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Continuous retrograde blood cardioplegia has been introduced as a promising alternative for myocardial protection during cardiac operations, although the optimal conditions for its delivery have been poorly studied. METHODS: We randomized a prospective series of 101 patients to receive either retrograde warm (37 degrees C) or mild hypothermic (28 degrees to 29 degrees C) blood cardioplegia during elective coronary artery bypass grafting. Warm blood cardioplegia was delivered to the aortic root until the heart was arrested, after which the regimen was switched to retrograde and continued either as warm or mild hypothermic cardioplegia. Oxygen consumption and transcardiac pH differences during aortic cross-clamping were determined, and postoperative creatine kinase-MB efflux, hemodynamic recovery, and clinical complications monitored. RESULTS: Clinical characteristics, cardioplegia delivery rates, aortic cross-clamp and cardiopulmonary bypass times, and the number of distal anastomoses were similar in both patient groups. Short intermissions in cardioplegia delivery during construction of distal anastomoses were allowed, the ischemia time in the mild hypothermic group being somewhat longer (8.3% +/- 1.1% versus 5.1% +/- 0.8% of cross-clamp time; p = 0.05). Myocardial oxygen consumption was lower in the mild hypothermic group (2.49 +/- 0.23 versus 3.93 +/- 0.33 mL/min at 30 minutes of cross-clamping; p < 0.01), and the transcardiac pH difference was smaller (0.05 +/- 0.01 versus 0.07 +/- 0.01 at 30 minutes of cross-clamping; p < 0.03). Postoperative creatine kinase-MB levels were higher in the normothermic group. Heart rate was higher and left ventricular stroke work index smaller in the warm group, but otherwise there were no major differences between the groups in hemodynamic recovery. The number of postoperative complications was also similar in both groups. CONCLUSIONS: Although both normothermic (37 degrees C) and mild hypothermic (28 degrees to 29 degrees C) retrograde blood cardioplegia, when delivered in near-continuous fashion, will offer safe myocardial protection during coronary artery bypass grafting, mild hypothermia seemed to provide somewhat better protection under the conditions prevailing here. The effects of different cardioplegia temperatures should perhaps be tested further in patients with recent myocardial infarction, unstable angina, or severely depressed left ventricular function.
Authors:
P Kaukoranta; M Lepoj?rvi; J Nissinen; P Raatikainen; K J Peuhkurinen
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  60     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1995 Oct 
Date Detail:
Created Date:  1995-11-08     Completed Date:  1995-11-08     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1087-93     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Oulu University Hospital, Finland.
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MeSH Terms
Descriptor/Qualifier:
Coronary Artery Bypass*
Creatine Kinase / blood
Female
Heart Arrest, Induced / methods*
Humans
Hypothermia, Induced
Isoenzymes
Male
Middle Aged
Prospective Studies
Temperature
Chemical
Reg. No./Substance:
0/Isoenzymes; EC 2.7.3.2/Creatine Kinase

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


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