Right Ventricle is Protected Better by Warm Continuous than by Cold Intermittent Retrograde Blood Cardioplegia in Patients with Obstructed Right Coronary Artery
| Autor: | L. Kaukinen, Erkki Pehkonen, Eva-Liisa Honkonen, Kaukinen S |
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| Rok vydání: | 1997 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Coronary Disease law.invention Left coronary artery law medicine.artery Internal medicine medicine Cardiopulmonary bypass Humans Prospective Studies Cardioplegic Solutions Analysis of Variance Cardiopulmonary Bypass Ejection fraction business.industry Hemodynamics Temperature Central venous pressure Stroke Volume Venous blood Middle Aged Cold Temperature Survival Rate Preload Treatment Outcome medicine.anatomical_structure Ventricle Right coronary artery Heart Arrest Induced Ventricular Function Right Cardiology Female Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Thoracic and Cardiovascular Surgeon. 45:182-189 |
| ISSN: | 1439-1902 0171-6425 |
| DOI: | 10.1055/s-2007-1013720 |
| Popis: | Preservation of the right-ventricular (RV) myocardium is a clinical challenge especially in patients with occluded right coronary artery, in whom antegrade cardioplegia cannot reach areas distal to the stenosis. Retrograde administration of cardioplegia has been thought to overcome the problem, but it has been blamed for inadequate distribution to the RV and possibly poorer functional recovery of this ventricle. Adapting the hypothesis that warm blood cardioplegia may offer better distribution and a more effective supply of oxygen to the arrested heart, we compared RV function in a randomised trial in patients with significant right and left coronary artery disease, after either warm continuous (warm group, n = 15) or intermittent cold (cold group, n = 14) retrograde blood cardioplegia. Right-ventricular function was assessed by determining the ejection fraction (fast-response thermodilution) and preload-related RV stroke work in repeated measurements. The RV ejection fraction remained steady in the warm group during the postoperative course, while it declined significantly in the cold group after operation and differed from that in the warm group until the second postoperative day (p < 0.05-0.001). The ratio of RV stroke work to right atrial pressure was greater postoperatively in the warm than in the cold group until 6 hours after cardiopulmonary bypass (p < 0.05-0.01). Creatine kinase cardiac isoenzyme release was greater in the cold group (p < 0.01). The relationship between left-ventricular stroke work and corresponding preload did not differ between the groups. It can be concluded that recovery of RV function after coronary surgery was better in terms of ejection fraction and preload-related stroke work with warm continuous cardioplegia than with intermittent cold cardioplegia, this along with lower cardiac enzyme release suggesting better RV protection. |
| Databáze: | OpenAIRE |
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