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The Journal of Thoracic and Cardiovascular Surgery, Vol 88, 726-741, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
SE Fremes, GT Christakis, RD Weisel, DA Mickle, MM Madonik, J Ivanov, R Harding, SJ Seawright, S Houle and PR McLaughlin
Although experimental studies suggest that blood cardioplegia provides
better protection than crystalloid cardioplegia, clinical studies have been
inconclusive. Ninety patients undergoing coronary bypass grafting were
randomized to receive either blood (n = 43) or crystalloid cardioplegia (n
= 47). The incidence of perioperative myocardial infarction was lower with
blood cardioplegia (blood, n = 0; crystalloid, n = 5; p = 0.06), and the
maximum MB isoenzyme of creatine kinase was significantly less with blood
cardioplegia (blood, 26.3 +/- 12.6 U/L; crystalloid, 35.6 +/- 17.0 U/L,
mean +/- standard deviation; p less than 0.02.) Sixty patients (blood
cardioplegia, n = 28; crystalloid cardioplegia, n = 32) had more sensitive
measurements to assess the metabolic response to aortic occlusion and to
compare the metabolic and functional recovery from the operation. Coronary
sinus blood flow (by the continuous thermodilution technique) was
significantly lower after cross-clamp removal with blood cardioplegia
(blood, 160 +/- 100 ml/min; crystalloid, 220 +/- 120 ml/min; p less than
0.05), indicating less reactive hyperemia. The cardiac production of
lactate was significantly less with blood cardioplegia during aortic
occlusion (blood, -0.5 +/- 0.9 mmol/L; crystalloid, -0.9 +/- 0.9 mmol/L; p
less than 0.05) and immediately after aortic declamping (blood, -0.2 +/-
0.4 mmol/L; crystalloid, -0.7 +/- 0.7 mmol/L; p less than 0.01).
Thermodilution cardiac output measurements permitted calculation of the
left ventricular stroke work index, and nuclear ventriculograms permitted
calculation of the left ventricular end- diastolic volume index and
end-systolic volume index. Myocardial performance, systolic elastance, and
diastolic compliance were determined from volume loading studies (250 to
500 ml colloid) performed 2 to 4 hours postoperatively. Myocardial
performance (the left ventricular stroke work index-left ventricular
end-diastolic volume index relation) and systolic elastance (the systolic
blood pressure-left ventricular end-systolic volume index relation) were
significantly better with blood cardioplegia (p less than 0.01 by
multivariate analysis); diastolic compliance (the left atrial pressure-
left ventricular end-diastolic volume index relation) was similar. Blood
cardioplegia reduced ischemic injury, decreased anaerobic metabolism during
arrest, and permitted better functional recovery. Blood cardioplegia
provides superior protection for elective coronary bypass grafting and may
improve the clinical results in patients with unstable angina and in other
high-risk patients.
ARTICLES
A clinical trial of blood and crystalloid cardioplegia
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J. M. Pearl, H. Laks, D. C. Drinkwater, A. Meneshian, S. M. Martin, M. Curzan, and P. A. Chang Fluosol cardioplegia results in complete functional recovery: A comparison with blood cardioplegia Ann. Thorac. Surg., December 1, 1992; 54(6): 1144 - 1150. [Abstract] [PDF]
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Y. A. G. Louagie, E. Collard, M. Gonzalez, A. Gruslin, J. Jamart, V. Delire, A. Mayne, M. Buche, and J.-C. Schoevaerdts Initial experience with low-potassium cold blood cardioplegia: A clinical comparative study Ann. Thorac. Surg., April 1, 1992; 53(4): 628 - 634. [Abstract] [PDF]
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H. B. Barner Blood cardioplegia: A review and comparison with crystalloid cardioplegia Ann. Thorac. Surg., December 1, 1991; 52(6): 1354 - 1367. [Abstract] [PDF]
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C. Munsch Review article : Blood cardioplegia Perfusion, October 1, 1991; 6(4): 245 - 252. [PDF]
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J. Vinten-Johansen, J. S. Julian, H. Yokoyama, W. E. Johnston, T. D. Smith, D. S. McGee, and A. R. Cordell Efficacy of myocardial protection with hypothermic blood cardioplegia depends on oxygen Ann. Thorac. Surg., October 1, 1991; 52(4): 939 - 948. [Abstract] [PDF]
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A. Coetzee, G. Roussouw, P. Fourie, and A. Lochner Preservation of myocardial function and biochemistry after blood and oxygenated crystalloid cardioplegia during cardiac arrest Ann. Thorac. Surg., August 1, 1990; 50(2): 230 - 237. [Abstract] [PDF]
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R. D. Weisel, D. A. G. Mickle, C. D. Finkle, L. C. Tumiati, M. M. Madonik, and J. Ivanov Delayed Myocardial Metabolic Recovery After Blood Cardioplegia Ann. Thorac. Surg., October 1, 1989; 48(4): 503 - 507. [Abstract] [PDF]
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K. S. Naunheim, A. C. Fiore, D. C. Arango, D. G. Pennington, H. B. Barner, L. R. McBride, H. H. Harris, V. L. Willman, and G. C. Kaiser Coronary artery bypass grafting for unstable angina pectoris: Risk analysis Ann. Thorac. Surg., April 1, 1989; 47(4): 569 - 574. [Abstract] [PDF]
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W. Mohl, P. Simon, F. Neumann, W. Schreiner, and C. Punzengruber Clinical Evaluation of Pressure-Controlled Intermittent Coronary Sinus Occlusion: Randomized Trial During Coronary Artery Surgery Ann. Thorac. Surg., August 1, 1988; 46(2): 192 - 201. [Abstract] [PDF]
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 R. T. Card, K. Prasad, B. Bharadwaj, L. A. P. Hnatuk, and M. A. MacFadyen High 2,3-DPG Blood Cardioplegia and Myocardial Preservation During Cardiopulmonary Bypass Angiology, February 1, 1988; 39(2): 123 - 131. [Abstract] [PDF]
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W. G. Hendren, D. D. O'Keefe, G. A. Geffin, A. G. Denenberg, T. R. Love, and W. M. Daggett Maximal Oxygenation of Dilute Blood Cardioplegic Solution Ann. Thorac. Surg., July 1, 1987; 44(1): 48 - 52. [Abstract] [PDF]
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K. H. Teoh, G. T. Christakis, R. D. Weisel, C. P. Tong, L. L. Mickleborough, H. E. Scully, B. S. Goldman, and R. J. Baird The Determinants of Mortality and Morbidity after Multiple-Valve Operations Ann. Thorac. Surg., April 1, 1987; 43(4): 353 - 358. [Abstract] [PDF]
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W. M. Daggett Jr., J. D. Randolph, M. Jacobs, D. D. O'Keefe, G. A. Geffin, L. A. Swinski, B. R. Boggs, and W. G. Austen The Superiority of Cold Oxygenated Dilute Blood Cardioplegia Ann. Thorac. Surg., April 1, 1987; 43(4): 397 - 402. [Abstract] [PDF]
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H. B. Barner, M. T. Swartz, J. E. Devine, G. A. Williams, and D. Janosik Diltiazem as an Adjunct to Cold Blood Potassium Cardioplegia: A Clinical Assessment of Dose and Prospective Randomization Ann. Thorac. Surg., February 1, 1987; 43(2): 191 - 197. [Abstract] [PDF]
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J. C. Mullen, S. E. Fremes, R. D. Weisel, G. T. Christakis, J. Ivanov, M. M. Madonik, S. Houle, and P. R. McLaughlin Right Ventricular Function: A Comparison Between Blood and Crystalloid Cardioplegia Ann. Thorac. Surg., January 1, 1987; 43(1): 17 - 24. [Abstract] [PDF]
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J. Vinten-Johansen, T. A. Edgerton, K. J. Hansen, P. Carroll, S. A. Mills, and A. R. Cordell Surgical Revascularization of Acute (1 Hour) Coronary Occlusion: Blood versus Crystalloid Cardioplegia Ann. Thorac. Surg., September 1, 1986; 42(3): 247 - 254. [Abstract] [PDF]
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S. Slogoff, A. S. Keats, D. A. Cooley, G. J. Reul, O. H. Frazier, D. A. Ott, J. M. Duncan, and J. J. Livesay Addition of Papaverine to Cardioplegia Does Not Reduce Myocardial Necrosis Ann. Thorac. Surg., July 1, 1986; 42(1): 60 - 64. [Abstract] [PDF]
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