摘要
Objectives A large number of experimental studies have indicated that blood ca rdioplegia might be superior to crystalloid cardioplegia for myocardial protecti on during ischemic arrest. However, no prospectively randomized studies of large patient series have been undertaken to prove potential differ ences in clinical course. Methods Over a 52-month period, all patients undergoi ng on-pump coronary artery bypass operated on by 2 surgeons were prospectively randomized to receive either cold crystalloid cardioplegia(group C) or cold bloo d cardioplegia(group B) during aortic crossclamping. Results Altogether, 1440 pa tients aged 37 to 89 years (median, 66 years) entered the study(group C, n=719; group B, n=721). The groups were comparable in all major demographic, preoperati ve, and operative variables. The clinical course turned out to be nearly identic al for both groups. No statistically significant differences were seen concernin g spontaneous sinus rhythm after aortic declamping, use of inotropic drugs or in tra-aortic balloon pumping, postoperative ventilatory support, bleeding and rat e of allogeneic blood transfusions, perioperative myocardial infarction, episode s of atrial fibrillation, stroke or minor neurologic dysfunction, renal function , infections, physical rehabilitation, or mortality. Also, in subgroups of patie nts at higher operative risk(female sex, age >70 years, unstable angina, diabete s, emergency operation, ejection fraction < 0.50, crossclamping time >50 minutes , andEuroSCORE >4), no statistically significant differences could be demonstrat ed between the groups. Conclusions There were no significant differences whether myocardial protection was performed with cold blood cardioplegia or cold crysta lloid cardioplegia during aortic crossclamping in patients undergoing coronary a rtery bypass grafting. The extra costs related to blood cardioplegia might be sa ved. Copyright.
Objectives A large number of experimental studies have indicated that blood ca rdioplegia might be superior to crystalloid cardioplegia for myocardial protecti on during ischemic arrest. However, no prospectively randomized studies of large patient series have been undertaken to prove potential differ ences in clinical course. Methods Over a 52-month period, all patients undergoi ng on-pump coronary artery bypass operated on by 2 surgeons were prospectively randomized to receive either cold crystalloid cardioplegia(group C) or cold bloo d cardioplegia(group B) during aortic crossclamping. Results Altogether, 1440 pa tients aged 37 to 89 years (median, 66 years) entered the study(group C, n=719; group B, n=721). The groups were comparable in all major demographic, preoperati ve, and operative variables. The clinical course turned out to be nearly identic al for both groups. No statistically significant differences were seen concernin g spontaneous sinus rhythm after aortic declamping, use of inotropic drugs or in tra-aortic balloon pumping, postoperative ventilatory support, bleeding and rat e of allogeneic blood transfusions, perioperative myocardial infarction, episode s of atrial fibrillation, stroke or minor neurologic dysfunction, renal function , infections, physical rehabilitation, or mortality. Also, in subgroups of patie nts at higher operative risk(female sex, age >70 years, unstable angina, diabete s, emergency operation, ejection fraction < 0.50, crossclamping time >50 minutes , andEuroSCORE >4), no statistically significant differences could be demonstrat ed between the groups. Conclusions There were no significant differences whether myocardial protection was performed with cold blood cardioplegia or cold crysta lloid cardioplegia during aortic crossclamping in patients undergoing coronary a rtery bypass grafting. The extra costs related to blood cardioplegia might be sa ved. Copyright.
