Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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A Clinical Study on Myocardial Metabolism in Warm Versus Cold Continuous Blood Cardioplegia

냉혈 및 온혈 심정지액의 연속관류시 심근대사에 대한 임상연구

  • Published : 1994.06.01
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Abstract

A clinical study was designed to evaluate myocardial metabolism during continuous cold blood cardioplegia [Group A, n=10] in comparison with continuous warm blood cardioplegia [Group B, n=10], in a prospective randomized manner. Myocardial metabolism was assessed in two ways: either by collecting blood from coronary sinus before and after cardiopulmonary bypass or by collecting blood from cardioplegic affluent and effluent simultaneously at the beginning and at the end of cardioplegia. The former samples were assayed for gas analysis, lactic acid and cardiac enzyme [CK, LDH, SGOT] and the latter for gas analysis and lactic acid as a maker of anaerobic metabolism. The results were as follows. 1] Myocardial metabolism was shown to be continued in the state of cardioplegia at lower temperature as evidenced by high oxygen extraction of cardioplegic solution in Group A. 2] Anaerobic metabolism occurring at lower temperature in spite of continuous cold blood cardioplegia can be significantly reduced by continuous perfusion of normothermic blood cardioplegics as evidenced by significant reduction of lactate production in Group B [p〈0.05]. 3] Better myocardial protection can be achieved by employing continuous warm blood cardioplegia as evidenced by less cardiac enzyme release in Group B after cardiopulmonary bypass.

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References

  1. Ann Thorac Surg v.175 Primary cause of unsucessful liver and heart transplantation: Cold sensitivity of the ATP-ase system Martin,D.R.;Scott,D.F.;Downer,G.L.(et al.)
  2. Comp Biochem Physiol v.44B Temperature induced phase changes in membrane of heart : a contrast between the thermal response of poikilotherms and homeotherms McMurchie,E.J.;Raison,J.K.;Cairncross,K.D.
  3. J Physiol(London) v.361 Effect of rapid cooling on mechanical and electrical responses in ventricular muscle of the guinea pig Sakai,T.;Kuihara,S.
  4. Ann Thorac Surg v.24 Left ventricular subendocardial necrosis Buckberg,G.D.
  5. Surg Gynecol Obstet v.109 Selective hypothernia of the heart in anoxic cardiac arrest Shumway,N.E.;Lower,R.E.;Stofer,R.C.
  6. Ann Surg v.153 Profound cardiac hypothermia Hufnagel,C.A.;Conrad,P.W.;Schanno.J.(et al.)
  7. J Thorac Cardiovasc Surg v.66 Profound local hypothermia for myocardial protection during open-heart surgery Griepp,R.B.;Stinson,E.B.;Shumway,N.E.
  8. Ann Thorac Surg v.33 Clinical evaluation of the relative effectiveness of multidose crystalloid and cold blood patassium cardioplegia in coronary artery bypass surgery Roberts,A.J.;Moran,J.M.;Standers,J.H.(et al.)
  9. A Textbook of clinical cardioplegia Blood cardioplegia-experience with prolonged cross-clamping Cunningham,J.N.;Catinella,F.P.;Spencer,F.C.;Engelman,R.M.;Levitsky,S.
  10. A Textbook of clinical cardioplegia Blood versus crystalloid cardioplegia Fabiani,J.N.;Perier,P.;Chelly,J.(et al.);sEngelman,R.M.;Levistsky,S.
  11. Ann Thorac Surg v.33 Myocardial protection with cold blood potassium cardioplegia during prolonged aortic cross-clamping Catinella,F.P.;Cunningham,J.N.;Adams,P.X.(et al.)
  12. J Thorac Cardiovasc Surg v.97 Studies of retrograde cardioplegia I. Advantages of antegrade | retrograde cardioplegia in jeopardized myocardium Partington,M.T.;Acar,C.;Buckberg,G.D.(et al.)
  13. J Thorac Cardiovasc Surg v.97 Studies of retrograde cardioplegia II. Nutritive blood distribution in normal and jeopardized myocardium Partington,M.T.;Acar,C.;Buckberg,G.D.(et al.)
  14. Ann Thorac Surg v.45 Efficacy of retrograde coronary sinus cardiopleiga in patients undergoing myocardial revascularization : A prospective randomized trial Diehl,J.T.;Eichhorn,E.J.;Konstam,M.A.(et al.)
  15. Surgical Forum v.39 Effects of right atrial cardioplegia on preservation of the ischemic right ventricle following acute coronary artery occlusion and reperfusion Kaplan,E.;Dresdale,A.R.;Kreis,A.(et al.)
  16. J Card Surg v.4 Antegrade | retrograde cardioplegia to ensure cardioplegic distribution : Operative techniques and objectives Buckberg,G.D.
  17. Scand J Thorac Cardiovasc Surg v.15 Myocardial protection during aortic valve replacement: cardiac metabolism and enzyme release following continuous blood cardioplegia Bonfin,V.;Kaijer,L.;Bendz,R.(et al.)
  18. J Thorac Cardiovasc Surg v.95 The superiority of continuous cold blood cardioplegia in the metabolic protection of the hypertrophied human heart Khuri,S.F.;Warner,K.G.;Josa,M.(et al.)
  19. A textbook of cardioplegia for difficult clinical problems A prospective randomized analysis of cold crystalloid, cold blood, and warm blood cardioplegia for coronary revascularization Engelman,R.M.;Ronson,J.A.;Flack III, J.E.(et al.);Engelman,R.M.;Levitsky,S.
  20. J Thorac Cardiovasc Surg v.101 Warm heart surgery Lichtenstein,S.V.;Ashe,K.A.;El Dalati H.(et al.)
  21. Ann Thorac Surg v.51 Retrograde continuous warm blood cardioplegia: A new concept in myocardial protection Salerno,T.A.;Houck,J.P.;Barrozo,C.A.(et al.)