• Journal of Chest Surgery
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• v.32 no.2
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• pp.130-137
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• 1999

Background: In cardiac surgery, hypothermia is associated with a number of major disadvantage, including its detrimental effects on enzymatic function, energy generation and cellular integrity. Warm cardioplegia with normothermic cardiopulmonary bypass cause three times more incidence of permanent neurologic deficits than the cold crystalloid cardioplegia with hypothermic cardiopulmonary bypass. Interruptions or inadequate distribution of warm cardioplegia may induce anaerobic metabolism and warm ischemic injury. To avoid these problems, tepid blood cardioplegia was recently introduced. Material and Method: To evaluate whether continuous tepid blood cardioplegia is beneficial in clinical practice during valvular surgery, we studied two groups of patients matched by numbers and clinical characteristics. Warm group(37$^{\circ}C$) consisted of 18 patients who underwent valvular surgery with continuous warm blood cardioplegia. Tepid group(32$^{\circ}C$) consisted of 17 patients who underwent valvular surgery with continuous tepid blood cardioplegia. Result: Heartbeat in 100% of the patients receiving continuous warm blood cardioplegia and 88.2% of the patients receiving continuous tepid blood cardioplegia converted to normal sinus rhythm spontaneously after removal of the aortic cross clamp. There were no differences between these two groups in CPB time, ACC time, the amount of crystalloid cardioplegia used and peak level of potassium. During the operation, the total amount of urine output was more in the warm group than the tepid group(2372${\pm}$243 ml versus 1535${\pm}$130 ml, p<0.01). There were no differences between the two groups in troponin T level measured 1hr and 12hrs after the operation. Conclusion: Continuous tepid blood cardioplegia is as safe and effective as continuous warm blood cardioplegia undergoing cardiac valve surgery in myocardial protection.

• Journal of Chest Surgery
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• v.36 no.11
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• pp.828-833
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• 2003

Background: It has been reported that the recently developed intermittent antegrade warm blood cardioplegia (IAWBC) has better myocardial protective effects during coronary artery bypass surgery than cold blood cardioplegia or continuos retrograde cold blood cardioplegia. The aim of this study is to evaluate the safety and usefulness of IAWBC by comparing it retrospectively with intermittent retrograde cold blood cardioplegia (lRCBC). Material and Method: From April 2001 to Feb. 2003, fifty seven patients who underwent isolated coronary surgery were divided into two groups (IAWBC vs. IRCBC). The two group had similar demographic and angiographic characteristics. There were no statistical differences in age, sex, Canadian Cardiovascular Society Functional Classification for angina, ejection fraction, and number of grafts. Result: Aortic cross clamping time and total pump time in IAWBC (99$\pm$23 and vs. 126$\pm$32 min) were shorter than those of IRCBC (118$\pm$32 min. and 185$\pm$48 min.)(p<0.05). The reperfusion time (13$\pm$7 min) in IAWBC was shorter than that of IRCBC (62$\pm$109 min.)(p<0.05). CKMB at 12 hours and 24 hours (16$\pm$15 and 9$\pm$13) in IAWBC was lower than that of IRCBC (33$\pm$47 and 17$\pm$26)(p<0.05). The awakening time in IAWBC (2$\pm$1 hour) was shorter than that of IRCBC (4$\pm$3)(p<0.05). The number of spontaneous heart beat recovery in IAWBC (85%) was more than that of IRCBC (35%)(p<0.05). The cardiac index after discontinuing cardio-pulmonary bypass was significantly elevated in the IAWBC group. The prevalence of perioperative myocardial infarction in IAWBC (4%) was lower than that of IRCBC group (20%)(p<0.05). Conclusion: Intermittent antegrade warm blood cardioplegia is a safe, reliable, and effective technique for myocardial protection. It can also provide simpler and economic way than the retrograde cold cardioplegia by shortening of cardiopulmonary bypass time and avoiding retrograde cannulation for coronary sinus.