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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 833-843, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
TM Yau, JS Ikonomidis, RD Weisel, DA Mickle, J Ivanov, MK Mohabeer, L Tumiati, S Carson and P Liu
Warm cardioplegia produced by essentially continuous infusion has been used
as an alternative to traditional cold intermittent infusion techniques
during cardiac surgery, but its effects on postoperative left ventricular
function have not been defined. We performed a randomized clinical trial to
assess the effects of warm and cold blood cardioplegia on load-independent
indices of ventricular function. Fifty- three patients were randomized to
warm (n = 27) or cold (n = 26) cardioplegia. Myocardial oxygen consumption,
lactate production, adenine nucleotides, and adenine nucleotide degradation
products were measured during cardioplegia and reperfusion. In 13 patients
per group, pressure-volume loops were constructed and ventricular function
was assessed 3 hours after the operation. Warm cardioplegia resulted in
greater myocardial lactate production but improved recovery of oxygen
consumption during reperfusion. Depletion of adenosine triphosphate was
similar between groups, but total adenine nucleotides (adenosine
triphosphate + adenosine diphosphate + adenosine monophosphate) fell
further during warm cardioplegia. Cold cardioplegia was associated with an
accumulation of adenosine diphosphate and adenosine monophosphate. Creatine
kinase MB isoenzyme release was reduced in the warm group. Three hours
after the operation, end-systolic elastance and preload- recruitable stroke
work index were increased after warm cardioplegia, and early diastolic
relaxation was also increased. Increased systolic function after warm
cardioplegia may have been related to improved myocardial protection,
elevated arterial lactate concentrations, or increased circulating
catecholamine levels. Altered diastolic compliance in the warm group may
reflect greater active relaxation during early diastolic filling.
ARTICLES
Ventricular function after normothermic versus hypothermic cardioplegia
Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada.
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N. Hayashida, J. S. Ikonomidis, R. D. Weisel, T. Shirai, J. Ivanov, S. Carson, M. K. Mohabeer, L. C. Tumiati, and D. A. G. Mickle Adequate distribution of warm cardioplegic solution J. Thorac. Cardiovasc. Surg., September 1, 1995; 110(3): 800 - 812. [Abstract] [Full Text]
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A. Mezzetti, A. M. Calafiore, D. Lapenna, R. Deslauriers, G. Tian, T. A. Salerno, A. M. Verna, G. Bosco, S. D. Pierdomenico, and F. Caccurullo Intermittent antegrade warm cardioplegia reduces oxidative stress and improves metabolism of the ischemic-reperfused human myocardium J. Thorac. Cardiovasc. Surg., April 1, 1995; 109(4): 787 - 795. [Abstract] [Full Text]
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N. Hayashida, R. D. Weisel, T. Shirai, J. S. Ikonomidis, J. Ivanov, S. M. Carson, M. K. Mohabeer, L. C. Tumiati, and D. A. G. Mickle Tepid Antegrade and Retrograde Cardioplegia Ann. Thorac. Surg., March 1, 1995; 59(3): 723 - 729. [Abstract] [Full Text]
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T. M. Yau, R. D. Weisel, D. A. G. Mickle, G. W. Burton, K. U. Ingold, J. Ivanov, M. K. Mohabeer, L. Tumiati, and S. Carson Vitamin E for coronary bypass operationsA prospective, double-blind, randomized trial J. Thorac. Cardiovasc. Surg., August 1, 1994; 108(2): 302 - 310. [Abstract] [Full Text]
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J. S. Ikonomidis, T. M. Yau, R. D. Weisel, N. Hayashida, X. Fu, M. Komeda, J. Ivanov, S. Carson, M. K. Mohabeer, L. Tumiati, et al. Optimal flow rates for retrograde warm cardioplegia J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 510 - 519. [Abstract] [Full Text]
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