A variant of blood, warm, low-volume, single-dose cardioplegia for myocardial revascularization
Abstract
It was a prospective, single-center trial of the
primary coronary artery bypass grafting hospital outcomes with two different
types of cardioplegic myocardial protection performed as follows: own
modification of warm, blood, low-volume, single-dose cardioplegia and cold
crystalloid cardioplegia with NTK-solution. The study was carried out
between 2016 and 2019. The proposed modification of cardioplegia was used
in 1735 patients. 376 of those patients were included in the main group
(blood cardioplegia group). Control group (crystalloid cardioplegia group)
consisted of 324 patients. Inclusion criteria were similar for both
groups: scheduled primary multiple coronary artery bypass grafting (CABG)
with cardiopulmonary bypass (CPB), revascularization index of ≥2,
comparable values according to the coronary bed lesion severity rating
scale (Syntax SCORE), aortic occlusion time ranged from 50 to 70 min. The
data is represented as Me (min-max).
The AV block was the underlying mechanism resulting in
asystole in 100% of patients (p<0.001)
in the blood cardioplegia group and ventricular fibrillation (VF) (p<0.001) was the main reason in
84% of patients included in the crystalloid cardioplegia group. After the
aortic cross-clamp was removed, the unaided heart activity recovery was
found in 84% (317 patients) in the blood cardioplegia group vs 68% (200
patients) in the crystalloid cardioplegia group (p=0.001) (VF) and the need for defibrillation was 6 vs 32% (p<0.03) respectively. Patients in the
crystalloid cardioplegia group had a more outstanding volemic load:
postoperative balance in the crystalloid cardioplegia group (Me 1720
vs 1350 ml; p=0.001) and the need for
hemotransfusion (28 vs 19.2%; p=0.001).
Inotropic and/or vasopressor therapy was used more frequently during
the perioperative period (31 vs 12%; p=0.01)
in the crystalloid cardioplegia group. The blood cardioplegia group
demonstrated less enzymatic activity (p<0.001)
when assessing the values of markers for myocardial injury such as CPK-MB
isozyme (creatine CPK-MB) and troponin T in 24 hours after the aortic
occlusion was relieved. There were no deaths in the blood
cardioplegia group while 2 (0.6%) patients died in the crystalloid
cardioplegia group. The other parameters considered are as follows: the
frequency of myocardial infarction, low cardiac output
syndrome, postoperative AF, CVA; duration of hospital stay did not
significantly differ between the groups (p>0.05).
Conclusion. The proposed method of blood, antegrade, low-volume, single-dose
cardioplegia is easy to perform and is a reliable, safe way to protect the
myocard during CABG with cross-clamp period of 50-70 min.
Keywords:cardiopulmonary bypass, myocardial revascularization, myocardial protection
Funding. The study had no
sponsor support.
Conflict of
interest. The authors
declare no conflict of interest.
For citation: Bazylev V.V.,
Evdokimov M.E., Pantyuhina M.A. A variant of blood, warm, low-volume,
single-dose cardioplegia for adult myocardial revascularization. Clinical and
Experimental Surgery. Petrovsky Journal. 2021; 9 (2): 68-75. DOI: https://doi.org/10.33029/2308-1198-2021-9-2-68-75 (in Russian)
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