Randomized trial of intermittent antegrade warm blood versus cold crystalloid cardioplegia

Background. We performed a prospective randomized trial to compare intermit tent antegrade warm blood cardioplegia with intermittent antegrade and retr ograde cold crystalloid cardioplegia. Methods. Two hundred consecutive patients scheduled for isolated coronary b ypass surgical procedures were randomized into two groups: Group 1 (n = 92) received cold crystalloid cardioplegia with moderate systemic hypothermia, group 2 (n = 108) received intermittent antegrade warm blood cardioplegia with systemic normothermia. Preoperative, intraoperative, and postoperative data were prospectively collected. Results. For the same median number of distal anastomoses, cardiopulmonary bypass duration and total ischemic arrest duration (57.3 +/- 20.5 versus 75 +/- 22.1 minutes, p < 0.001) were shorter in group 2 than in group 1. Apar t from a higher right atrial pressure in the cold cardioplegia group, no he modynamic difference was observed. Aspartate aminotransferase, creatine kin ase-MB fraction, and cardiac troponin I levels were significantly lower in group 2 than in group 1. Outcome variables were not significantly different . Conclusions. Intermittent antegrade warm blood cardioplegia results in less myocardial cell damage than cold crystalloid cardioplegia, as assessed by the release of cardiac-specific markers. This beneficial effect has only ma rginal clinical consequences. Normothermic bypass has no deleterious effect on end-organ function. (C) 1999 by The Society of Thoracic Surgeons.