INTERMITTENT ANTEGRADE WARM BLOOD CARDIOPLEGIA

Intermittent antegrade warm blood cardioplegia has been used routinely at our institution over the last 3 years. We report here a comparison between the first 250 consecutive patients undergoing elective corona ry artery bypass grafting in which intermittent antegrade warm blood c ardioplegia was used (group A) and the last 250 consecutive patients w ho received intermittent antegrade cold blood cardioplegia, during byp ass grafting (group B). There were no differences in sex, age, number of grafts, and functional status between the two groups; left ventricu lar ejection fraction was lower in group A. The overall mortality rate in group A was 0.8% versus 3.6% in group B (p < 0.05). There was no i n-hospital mortality among high-risk patients (ejection fraction less than or equal to 0.35) in group A (0/53) versus two deaths in group B (2/28) (p < 0.05). No patient in group A needed circulatory assistance ; 4 patients in group B received intraaortic balloon pumping. Only 1 p atient in group A required inotropic support versus 20 patients in gro up B (p < 0.0005), and 5 patients in group A received lidocaine hydroc hloride for ventricular arrhythmias versus 18 in group B (p < 0.01). T he rates of myocardial infarction and stroke were not different betwee n the two groups. The peak concentration of the myocardial-specific is oenzyme of creatine kinase were higher in group B in absolute value (5 1 +/- 30 nm) than in group A (38 +/- 38 IU/L) (p < 0.0005) and in perc ent of total creatine kinase (8.2% +/- 4.1% versus 6.2% +/- 2.9%, resp ectively). Group A patients awoke earlier (2.7 +/- 1.5 hours versus 3. 9 +/- 2.8 hours; p < 0.0005) and had a shorter stay in the intensive c are unit (28 +/- 7 hours versus 43 +/- 10 hours; p < 0.0005) than grou p B patients. We conclude that intermittent antegrade warm blood cardi oplegia is a safe, reliable, and effective technique of myocardial pro tection that deserves further assessment.