Prospective, randomized trial comparing blood and oxygenated crystalloid cardioplegia in reoperative coronary artery bypass grafting

• Published in: Journal of thoracic and cardiovascular surgery Vol. 115; no. 5; pp. 1166 - 1171
• Main Authors: Shanewise, Jack S., Kosinski, Andrzej S., Coto, Jorge A., Jones, Ellis L.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-05-1998; AATS/WTSA; Elsevier
• Subjects: Bicarbonates - administration & dosage; Biological and medical sciences; Calcium Chloride - administration & dosage; Cardioplegic Solutions - administration & dosage; Coronary Artery Bypass; Echocardiography, Transesophageal; Female; Follow-Up Studies; Heart Arrest, Induced - methods; Humans; Isotonic Solutions; Magnesium - administration & dosage; Male; Medical sciences; Middle Aged; Myocardial Contraction; Myocardial Ischemia - blood; Myocardial Ischemia - physiopathology; Myocardial Ischemia - surgery; Oxygen; Plasma Substitutes - administration & dosage; Potassium Chloride - administration & dosage; Prospective Studies; Reoperation; Sodium Chloride - administration & dosage; Stroke Volume; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Ventricular Function, Left - physiology; Sonography; Heart; Human; Postoperative; Cardioplegic solution; Reoperation; Echocardiography; Treatment efficiency; Contractility; Cardioplegia; Induced cardiocirculatory arrest; Blood; Aortocoronary; Crystalloid solution; Bypass; Surgery; Graft; Left ventricle performance; Esophageal route; Protection; Comparative study
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/S0022-5223(98)70417-9

Objectives: Reoperative coronary artery bypass grafting presents unique challenges for myocardial preservation. The purpose of this study was to compare oxygenated blood cardioplegia with oxygenated crystalloid cardioplegia during reoperative coronary artery bypass grafting using transesophageal echocardiography to assess regional wall motion of the left ventricle before and after cardiopulmonary bypass.
Methods: Sixty-one patients undergoing reoperative coronary artery bypass grafting were prospectively randomized to receive oxygenated blood cardioplegia or oxygenated crystalloid cardioplegia delivered with a combined antegrade-retrograde technique. Transgastric short axis views of the left ventricle were made with transesophageal echocardiography during the operation before cardiopulmonary bypass and immediately after cardiopulmonary bypass. Regional wall motion was graded by a blinded observer, and before cardiopulmonary bypass scores were compared with after cardiopulmonary bypass scores.
Results: No significant differences were found in the change in regional wall motion score from before cardiopulmonary bypass to after cardiopulmonary bypass between the blood and crystalloid cardioplegia groups.
Conclusions: This study found blood and crystalloid cardioplegia to be equally efficacious for myocardial preservation during reoperative coronary artery bypass grafting. (J Thorac Cardiovasc Surg 1998;115:1166-71)