IS CONTINUOUS NORMOTHERMIC BLOOD CARDIOPLEGIA REALLY A PRACTICAL WAY OF MYOCARDIAL PRESERVATION - COMPARISON WITH INTERMITTENT COLD CRYSTALLOID CARDIOPLEGIA

Commencing in September 1991, 30 consecutive patients who underwent co ronary artery bypass grafting were operated on employing continuous no rmothermic blood cardioplegia (Group 1). 2.83 +/- 0.81 distal anastomo ses per patient were performed. The next 30 consecutive patients were operated on employing intermittent cold crystalloid cardioplegia (Grou p 2). 2.72 +/- 0.95 distal anastomoses per patient were performed in t his group. Cross clamping and cardiopulmonary bypass times were simila r in both groups. Electromechanical activity beginning time (69.00 +/- 94.04 sec. versus 101.50 +/- 78.26 sec., p < 0.001) and QRS recovery time (10.92 +/- 8.35 min.verus 19.60 +/- 33.65 min., p < 0.05) were si gnificantly shorter in Group 1 than in Group 2. Maximal potassium leve ls during cardiopulmonary bypass and in the postoperative period did n ot significantly differ between the groups. Postoperative serum CPK-MB values were similar. Three patients in Group 1 and four in Group 2 ne eded IABP support in the early postoperative period. In Group 1, one a nd in Group 2 three patients suffered perioperative myocardial infarct ion (difference not significant). Postoperative cardiac index augmenta tion was significantly higher in Group 1 than in Group 2 (from 2.40 +/ - 0.57 L/min/m2 to 3.04 +/- 0.60 L/min/m2 in Gr I, from 2.39 +/- 0.64 L/min/m2 to 2.86 +/- 0.49 L/min/m2 in Gr II, p < 0.01). Coronary sinus oxygen saturations during aortic cross-clamping were significantly hi gher in Group 1 (53.32 +/- 12.18 % versus 17.82 +/- 2.75%, p < 0.001). There were no rhythm disturbances in Group 1 (0%) but atrial fibrilla tion occurred in 5 (16.66%) cases of the hypothermic group in the post operative period. In Group 1, two patients, and in Group 2, three pati ents (difference is not significant) were lost in the early postoperat ive period. We can say that continuous normothermic blood cardioplegia is a safe alternative way of myocardial protection with good clinical results despite its discomfortable and complicated delivery technique .