| A Comparison of the Effect of Cold Crystalloid Versus Normothermic Blood Cardioplegia on the Postoperative Recovery in Valvular Heart Surgery. |
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Sei Kwan Bae, Kyoung Min Lee, Hyun Kyo Lim, Kwang Ho Lee, Soon Yul Kim, Dae Ja Um |
1Department of Anesthesiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
2Department of Anethesiology, Dongin General Hospital, Kangnung, Korea.
3Department of General Surgery, Ajou University of School of Medicine, Suwon, Korea. |
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| Abstract |
BACKGROUND
Recent interest in the use of normothermic blood cardioplegia is based on theoretical advantages over the traditional method of hypothermic myocardial protection.
These reported advantages are a decrease in intraaortic balloon pump use, greater incidence of return to normal sinus rhythm, greater immediate cardiac outputs, and less time weaned from bypass after removal of the aortic cross-clamp. In addition to these advantages, normothermic blood cardioplegia offers the promise to resuscitate the ischemic myocardium and reduce the morbidity and mortality for patients with high-risk disease. This study was designed to compare the effects of cold crystalloid and normothermic blood cardioplegia on the postoperative recovery.
METHODS
To evaluate the efficacy of cold versus normothermic cardioplegia, forty-four patients scheduled to undergoing valvular replacement surgery were selected to receive intermittent cold(4degrees C) crystalloid cardioplegia(n=22), group I or continuous normothermic(37degrees C) blood cardioplegia(n=22), group II. Cardiopulmonary bypass(CPB) and aortic cross-clamp(ACC) times were measured during the operation and patients were evaluated postoperatively for serum electrolytes, arterial blood gas analysis, blood pressure, heart rate, complications, ventilator periods and ICU stay.
RESULTS
The ACC and CPB times were significantly longer in group II(165.9+/-44.8 min, 210.9+/-60.2 min) compared with group I(121.2+/-38.7 min, 149.7+/-38.1 min)(p<0.01). Group II patients had significantly higher serum potassium level(5.2+/-0.8 mEq/L) than group I(4.3+/-0.4 mEq/L) on the first postoperative day(p<0.01). ICU stay and ventilator period were not significantly different in two groups. There was no significant difference in postoperative complications and mortality rates between two groups.
CONCLUSIONS
These results suggest that the continuous normothermic blood cardioplegia may be useful in myocardial protection during cardiac operation. |
| Key Words:
Heart; cardioplegia; cold crystalloid; normothermic blood; myocardial protection; Surgery; cardiac |
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