Long term left ventricular systolic function assessment following CABG - Aprospective, randomised study. Blood versus cristalloid cardioplegia

Background In an effort to define the role of blood cardioplegia delivered in antegrade/retrogade fashion in patients with either good or poor left ve ntricular function undergoing elective coronary artery bypass surgery, we i nitiated a prospective randomised study in which postoperative hemodynamics besides clinical data were compared in patients administered antegrade/ret rograde crystalloid cardioplegia, Methods. To compare the efficiency of two methods of myocardial protection - cold crystalloid ante/retro cardioplegia and cold blood ante/retro cardio plegia in two groups of patients with high and low LVEF - we randomised 122 patients for CABG, The potential improvement in left ventricular systolic function assessed by echocardiography and the same clinical data were the e nd points of the study, Patients were divided into group 1(47 patients, LVE F < 40%) and group Il (75 patients, LVEF > 40%), Pathologic antecedents and preoperative clinical conditions were similar in both randomised subgroups Ia, IIa (crystalloid cardioplegia) and subgroups Ib, IIb (blood cardiopleg ia), The following parameters were measured: left atrium diameter CLA), lef t ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), left ventricu lar wall motion score index (WMSI), and area asynergy (AA). All patients un derwent echocardiography: A - prior the CABG, B - 2-6 weeks postoperatively , C - 3 months postoperatively, D - 6 months postoperatively, E - 1 year po stoperatively, Results, The results of clinical assessment in both groups showed improveme nt of quality of Life. The constant improvement of LVEF and WMSI was observ ed in group I in contrast to group II. There were no significant difference s in postoperative left ventricular systolic function between subgroups Ia and Ib or IIa and IIb, Conclusions. The use of blood cardioplegia, instead of crystalloid cardiopl egia, when used in the ante/retrograde fashion during CABG has no influence on postoperative left ventricular systolic function, The improvement in le ft ventricular systolic function following CABG is greater in patients with low LVEF in contrast to patients with high LVEF.