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The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 877-887, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RA Guyton, LM Dorsey, JM Craver, DK Bone, EL Jones, DA Murphy and CR Hatcher Jr
Possible enhancement of myocardial protection by oxygenation of a
crystalloid cardioplegic solution was evaluated in a three-part study. In
Part I, canine hearts underwent ischemia followed by heterogeneous
cardioplegic arrest for 45 to 60 minutes. Oxygenation led to improved
recovery in the left anterior descending region (47% versus 86% recovery, p
less than 0.05) (15 minutes of ischemia) and in the circumflex region (9.5%
versus 52% recovery, p less than 0.05) (30 minutes of ischemia). Part II
was a blind prospective randomized study in 12 patients. It examined
creatine kinase, myoglobin, and lactate as well as coronary sinus flow,
oxygen consumption, and cardiac work 1 hour after aortic cross-clamping
during atrial and during ventricular pacing. No significant difference was
demonstrable between control and oxygenated solutions. In Part III, 57
coronary bypass patients were protected with a nonoxygenated solution while
94 patients received an identical oxygenated solution. Twelve-hour creatine
kinase levels were similar in the nonoxygenated (9.5 +/- 16 IU, +/-
standard deviation) and oxygenated (11 +/- 22 IU) groups if the cross-clamp
interval was 28 minutes or less. In patients subjected to longer than 28
minutes of arrest, the 12 hour creatine kinase MB levels were more than
twice as high in the nonoxygenated group (26.5 +/- 26 IU) compared to the
oxygenated group (9.9 +/- 14 IU, p less than 0.05). In this canine model of
heterogeneous cardioplegia and in the routine conduct of coronary bypass
operations, oxygenated crystalloid cardioplegia is superior to an identical
nonoxygenated solution.
ARTICLES
Improved myocardial recovery after cardioplegic arrest with an oxygenated crystalloid solution
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G. Merin and N. H. Fishman Preparation of Oxygenated Cold Crystalloid Cardioplegic Solution Ann. Thorac. Surg., June 1, 1986; 41(6): 679 - 679. [Abstract] [PDF]
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