The efficacy and safety of extending the ischemic time with a modified cardioplegic technique for coronary artery surgery
| Autor: | Gheorghe Cerin, Claudio Alessi, Guido Lanzillo, Edmond Stelian, Stefano Casalino, Luca Renzi, Marco Diena, Eugenio Novelli, Ugo Filippo Tesler |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Pulmonary and Respiratory Medicine
Inotrope Male medicine.medical_specialty Coronary artery surgery Every 15 minutes Cardiotonic Agents Time Factors medicine.medical_treatment Vasodilator Agents Myocardial Ischemia Vasodilation Coronary Artery Disease Creatine Revascularization law.invention Body Temperature chemistry.chemical_compound law Internal medicine medicine Myocardial Revascularization Creatine Kinase MB Form Humans Prospective Studies Cardioplegic Solutions Aged Ultrasonography business.industry Cardiovascular Surgical Procedures Length of Stay Intensive care unit medicine.anatomical_structure chemistry Anesthesia Cardiology Heart Arrest Induced Surgery Female Cardiology and Cardiovascular Medicine business Biomarkers Artery |
| Zdroj: | Journal of cardiac surgery. 23(5) |
| ISSN: | 1540-8191 |
| Popis: | BACKGROUND AND AIM The need to intermittently discontinue the administration of cardioplegia in order to complete the surgical procedure is a major drawback of antegrade warm blood cardioplegia. An ischemic time of 15 minutes is generally considered safe based on empirical observation. The aim of this study was the evaluation of the efficacy and safety of an intermittent warm blood cardioplegia with intervals between administrations prolonged to 25 minutes. METHODS Ninety-seven patients undergoing primary elective coronary artery revascularization were prospectively randomized into two groups. The first, Intermittent Antegrade Warm Blood Cardioplegia (IAWBC) group, comprising 49 patients, received standard intermittent antegrade warm blood cardioplegia repeated every 15 minutes. The second, Modified Intermittent Antegrade Warm Blood Cardioplegia (M-IAWBC) group, comprising 48 patients, received intermittent antegrade warm blood cardioplegia supplemented with magnesium sulfate (MgSO(4)), delivered in volumes proportional to the ventricular mass and repeated every 25 minutes. The clinical outcomes were evaluated. The levels of creatine kinase-MB (CK-MB) isoenzyme, in addition to the echocardiographic assessment of septal dyskinesia and tricuspid annulus plane systolic excursion (TAPSE), have been used as markers of myocardial damage. RESULTS There were no statistically significant differences in clinical outcomes, need for inotropes and vasodilators, length of stay in the intensive care unit, and postoperative levels of CK-MB between the two groups. Likewise, postoperative echocardiographic assessment showed no relevant differences. CONCLUSIONS Administration of warm antegrade cardioplegic solution supplemented with MgSO(4), delivered in volumes proportional to ventricular mass every 25 minutes, provides adequate myocardial protection for coronary artery surgery. |
| Databáze: | OpenAIRE |
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