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Is continuous normothermic blood cardioplegia really a practical way of myocardial preservation? Comparison with intermittent cold crystalloid cardioplegia. 1993

M Demirtas, and S Dagsali, and S Tarcan, and U Sungu

Istanbul Thoracic and Cardiovascular Surgery Center, Turkey.

Commencing in September 1991, 30 consecutive patients who underwent coronary artery bypass grafting were operated on employing continuous normothermic blood cardioplegia (Group 1). 2.83 +/- 0.81 distal anastomoses per patient were performed. The next 30 consecutive patients were operated on employing intermittent cold crystalloid cardioplegia (Group 2). 2.72 +/- 0.95 distal anastomoses per patient were performed in this group. Cross clamping and cardiopulmonary bypass times were similar in both groups. Electromechanical activity beginning time (69.00 +/- 94.04 sec. versus 101.50 +/- 78.26 sec., p < 0.001) and QRS recovery time (10.92 +/- 8.35 min. verus 19.60 +/- 33.65 min., p < 0.05) were significantly shorter in Group 1 than in Group 2. Maximal potassium levels during cardiopulmonary bypass and in the postoperative period did not significantly differ between the groups. Postoperative serum CPK-MB values were similar. Three patients in Group 1 and four in Group 2 needed IABP support in the early postoperative period. In Group 1, one and in Group 2 three patients suffered perioperative myocardial infarction (difference not significant). Postoperative cardiac index augmentation was significantly higher in Group 1 than in Group 2 (from 2.40 +/- 0.57 L/min/m2 to 3.04 +/- 0.60 L/min/m2 in Gr I, from 2.39 +/- 0.64 L/min/m2 to 2.86 +/- 0.49 L/min/m2 in Gr II, p < 0.01). Coronary sinus oxygen saturations during aortic cross-clamping were significantly higher in Group 1 (53.32 +/- 12.18% versus 17.82 +/- 2.75%, p < 0.001). There were no rhythm disturbances in Group 1 (0%) but atrial fibrillation occurred in 5 (16.66%) cases of the hypothermic group in the postoperative period. In Group 1, two patients, and in Group 2, three patients (difference is not significant) were lost in the early postoperative period. We can say that continuous normothermic blood cardioplegia is a safe alternative way of myocardial protection with good clinical results despite its discomfortable and complicated delivery technique.

UI	MeSH Term	Description	Entries
D007036	Hypothermia, Induced	Abnormally low BODY TEMPERATURE that is intentionally induced in warm-blooded animals by artificial means. In humans, mild or moderate hypothermia has been used to reduce tissue damages, particularly after cardiac or spinal cord injuries and during subsequent surgeries.	Induced Hypothermia,Mild Hypothermia, Induced,Moderate Hypothermia, Induced,Targeted Temperature Management,Therapeutic Hypothermia,Hypothermia, Therapeutic,Induced Mild Hypothermia,Induced Mild Hypothermias,Induced Moderate Hypothermia,Induced Moderate Hypothermias,Mild Hypothermias, Induced,Moderate Hypothermias, Induced,Targeted Temperature Managements
D007527	Isoenzymes	Structurally related forms of an enzyme. Each isoenzyme has the same mechanism and classification, but differs in its chemical, physical, or immunological characteristics.	Alloenzyme,Allozyme,Isoenzyme,Isozyme,Isozymes,Alloenzymes,Allozymes
D008297	Male		Males
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D009206	Myocardium	The muscle tissue of the HEART. It is composed of striated, involuntary muscle cells (MYOCYTES, CARDIAC) connected to form the contractile pump to generate blood flow.	Muscle, Cardiac,Muscle, Heart,Cardiac Muscle,Myocardia,Cardiac Muscles,Heart Muscle,Heart Muscles,Muscles, Cardiac,Muscles, Heart
D010101	Oxygen Consumption	The rate at which oxygen is used by a tissue; microliters of oxygen STPD used per milligram of tissue per hour; the rate at which oxygen enters the blood from alveolar gas, equal in the steady state to the consumption of oxygen by tissue metabolism throughout the body. (Stedman, 25th ed, p346)	Consumption, Oxygen,Consumptions, Oxygen,Oxygen Consumptions
D001831	Body Temperature	The measure of the level of heat of a human or animal.	Organ Temperature,Body Temperatures,Organ Temperatures,Temperature, Body,Temperature, Organ,Temperatures, Body,Temperatures, Organ
D002315	Cardiopulmonary Bypass	Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs.	Heart-Lung Bypass,Bypass, Cardiopulmonary,Bypass, Heart-Lung,Bypasses, Cardiopulmonary,Bypasses, Heart-Lung,Cardiopulmonary Bypasses,Heart Lung Bypass,Heart-Lung Bypasses
D003327	Coronary Disease	An imbalance between myocardial functional requirements and the capacity of the CORONARY VESSELS to supply sufficient blood flow. It is a form of MYOCARDIAL ISCHEMIA (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels.	Coronary Heart Disease,Coronary Diseases,Coronary Heart Diseases,Disease, Coronary,Disease, Coronary Heart,Diseases, Coronary,Diseases, Coronary Heart,Heart Disease, Coronary,Heart Diseases, Coronary
D003402	Creatine Kinase	A transferase that catalyzes formation of PHOSPHOCREATINE from ATP + CREATINE. The reaction stores ATP energy as phosphocreatine. Three cytoplasmic ISOENZYMES have been identified in human tissues: the MM type from SKELETAL MUSCLE, the MB type from myocardial tissue and the BB type from nervous tissue as well as a mitochondrial isoenzyme. Macro-creatine kinase refers to creatine kinase complexed with other serum proteins.	Creatine Phosphokinase,ADP Phosphocreatine Phosphotransferase,ATP Creatine Phosphotransferase,Macro-Creatine Kinase,Creatine Phosphotransferase, ATP,Kinase, Creatine,Macro Creatine Kinase,Phosphocreatine Phosphotransferase, ADP,Phosphokinase, Creatine,Phosphotransferase, ADP Phosphocreatine,Phosphotransferase, ATP Creatine