Mudassir Iqbal Dar1. 1. Department of Cardiothoracic Surgery, Liaquat National Hospital, Karachi, Pakistan.
Abstract
PURPOSE:Intermittent cold crystalloid cardioplegia by antegrade route to arrest the heart for coronary artery bypass grafting (CABG) is a commonly used technique. The aim of this study is to compare the intermittent antegrade warm blood cardioplegia with cold crystalloid cardioplegia by means of measuring myocardial injury markers CKMB and troponin T. We also compared the results with antegrade and retrograde warm blood cardioplegia. MATERIALS AND METHODS: Patients (n=30) undergoing CABG were prospectively randomized into group 1 (n=10) which received cold crystalloid cardioplegia by antegrade route, group 2 (n=10) which received warm blood cardioplegia by antegrade route and group 3 (n=10) which received antegrade/retrograde warm blood cardioplegia. RESULTS: Preoperative and intraoperative variables were equal in all three groups. Control levels of troponin T and CKMB were in a normal range. Postoperative troponin T was significantly lower in group 3 compared to group 2 (p"=0.008") and to group 1 (p"=0.005"). CKMB is significantly higher in group 1 compared to group 2 (p"=0.013") and higher in group 2 than that in group 3 (p"=0.043"). CONCLUSION:Antegrade with retrograde warm blood cardioplegia is a simple delivery method. Troponin T and CKMB levels were significantly lower, suggesting that this offered better myocardial protection than antegrade cold crystalloid and warm blood cardioplegia. We recommend its wider use.
RCT Entities:
PURPOSE: Intermittent cold crystalloid cardioplegia by antegrade route to arrest the heart for coronary artery bypass grafting (CABG) is a commonly used technique. The aim of this study is to compare the intermittent antegrade warm blood cardioplegia with cold crystalloid cardioplegia by means of measuring myocardial injury markers CKMB and troponin T. We also compared the results with antegrade and retrograde warm blood cardioplegia. MATERIALS AND METHODS:Patients (n=30) undergoing CABG were prospectively randomized into group 1 (n=10) which received cold crystalloid cardioplegia by antegrade route, group 2 (n=10) which received warm blood cardioplegia by antegrade route and group 3 (n=10) which received antegrade/retrograde warm blood cardioplegia. RESULTS: Preoperative and intraoperative variables were equal in all three groups. Control levels of troponin T and CKMB were in a normal range. Postoperative troponin T was significantly lower in group 3 compared to group 2 (p"=0.008") and to group 1 (p"=0.005"). CKMB is significantly higher in group 1 compared to group 2 (p"=0.013") and higher in group 2 than that in group 3 (p"=0.043"). CONCLUSION: Antegrade with retrograde warm blood cardioplegia is a simple delivery method. Troponin T and CKMB levels were significantly lower, suggesting that this offered better myocardial protection than antegrade cold crystalloid and warm blood cardioplegia. We recommend its wider use.
Authors: Thompson Ka Ming Kot; Jeffrey Shi Kai Chan; Saied Froghi; Dawnie Ho Hei Lau; Kara Morgan; Francesco Magni; Amer Harky Journal: JTCVS Open Date: 2021-03-31