INTERMITTENT ANTEGRADE WARM VERSUS COLD BLOOD CARDIOPLEGIA - A PROSPECTIVE, RANDOMIZED STUDY

A prospective, randomized study was performed in 200 patients undergoi ng coronary artery bypass grafting to compare the myocardial protectio n obtained with intermittent antegrade warm versus cold blood cardiopl egia. Preoperative and surgical characteristics of the two cohorts wer e similar. Intermittent antegrade infusion of warm blood cardioplegia failed to achieve sustained electromechanical arrest of the heart in 1 3%. The only difference in clinical outcomes was the more frequent spo ntaneous return to sinus rhythm after the unclamping of the aorta in t he warm group (88% versus 70%, p = 0.002). Mortality (1% each) and myo cardial infarction (2% and 4%) rates were similar. Rates of increase i n serum activity of the isoenzyme of creatine kinase (CKMB), CK-MB mas s concentration, and cardiac troponin-T level as well as total release of troponin T were significantly lower in the warm group, and fewer p atients in this group had a clinically significant increase in serum C K-MB mass (20% versus 398, p = 0.005) and troponin T (20% versus 56%, p = 0.00001). Thus, intermittent antegrade warm blood cardioplegia is appropriate and clinically safe; the lower release of biochemical mark ers of myocardial damage suggests improved protection during first-tim e coronary artery bypass grafting.