Randomized trial of intermittent antegrade warm blood versus cold crystalloid cardioplegia.
(1999) The Annals of Thoracic Surgery — Vol. 67, n° 2, p. 471-477 (1999)
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- BACKGROUND: We performed a prospective randomized trial to compare intermittent antegrade warm blood cardioplegia with intermittent antegrade and retrograde cold crystalloid cardioplegia. METHODS: Two hundred consecutive patients scheduled for isolated coronary bypass surgical procedures were randomized into two groups: Group 1 (n = 92) received cold crystalloid cardioplegia with moderate systemic hypothermia, group 2 (n = 108) received intermittent antegrade warm blood cardioplegia with systemic normothermia. Preoperative, intraoperative, and postoperative data were prospectively collected. RESULTS: For the same median number of distal anastomoses, cardiopulmonary bypass duration and total ischemic arrest duration (57.3 +/- 20.5 versus 75 +/- 22.1 minutes, p < 0.001) were shorter in group 2 than in group 1. Apart from a higher right atrial pressure in the cold cardioplegia group, no hemodynamic difference was observed. Aspartate aminotransferase, creatine kinase-MB fraction, and cardiac troponin I levels were significantly lower in group 2 than in group 1. Outcome variables were not significantly different. CONCLUSIONS: Intermittent antegrade warm blood cardioplegia results in less myocardial cell damage than cold crystalloid cardioplegia, as assessed by the release of cardiac-specific markers. This beneficial effect has only marginal clinical consequences. Normothermic bypass has no deleterious effect on end-organ function.
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Jacquet, L.-M., Noirhomme, P., Van Dyck, M., El Khoury, G., Matta, A., Goenen, M., & Dion, R. A. (1999). Randomized trial of intermittent antegrade warm blood versus cold crystalloid cardioplegia. The Annals of Thoracic Surgery, 67(2), 471-477. https://doi.org/10.1016/S0003-4975(98)01198-9 (Original work published 1999)