A randomized comparison of crystalloid and blood-containing cardioplegic solutions in 60 patients.

Abstract

To determine whether adding blood to a cardioplegic solution affects myocardial preservation, a randomized prospective study was carried out in 60 patients undergoing coronary revascularization to compare the effects of crystalloid potassium cardioplegics (group C) and potassium cardioplegic solutions to which blood has been added ( 973-982, 1984. ALTHOUGH blood-containing cardioplegic solutions have been shown to provide adequate myocardial protection during periods of aortic occlusion,'-' their use in preference to blood-free crystalloid solutions is still controversial. The inclusion of blood in cardioplegic solutions was devised as a means to enhance their myocardial protective characteristics, mainly through increased oxygen-carrying capacity. However, the value of blood as a means of delivery of oxygen to the myocardium has been questioned.9-'' The benefit of blood as a constituent of the cardioplegic solution may vary depending on the temperature and method of administration.3' 10 To explore whether addition of blood to a cardioplegic solution could affect myocardial preservation, a randomized prospective study was conducted to compare the effects of blood-free crystalloid and blood-containing cardioplegic solutions on markers of myocardial metabolism, myocardial damage, MethodsSixty patients scheduled for elective coronary artery revascularization were studied in a protocol approved by the institutional review board of the University of Alabama in Birmingham.They were assigned to receive either a blood-containing (group B, n = 31) or a clear crystalloid (

Myocardial oxygen tension during surgical revascularization.☆A clinical comparison between blood cardioplegia and crystalloid cardioplegia

“…This conclusion correlates with the results of Buttner et al [12] who showed an almost identical paraclinical, clinical, and biochemical outcomes after surgery with blood and crystalloid cardioplegia. Thus, the beneficial effect of blood cardioplegia compared to crystalloid cardioplegia observed by others [3][4][5][6][7][8][9][10][11] must be due to other features than the oxygen carrying capacity of blood.…”

“…In several of these studies, it has been suggested that addition of blood to cardioplegic solutions increases oxygen supply to the myocardium. On the other hand, a number of studies [12][13][14][15][16] show similar myocardial protective value of both cardioplegic methods. In all these studies, the cardioprotective value of the cardioplegic solutions was evaluated by hemodynamic or biochemical parameters such as systolic and diastolic function, myocardial oxygen consumption, creatine kinase myocardial band (CKMB), lactate, ATP, etc., and the myocardial oxygenation has been described only qualitatively by extrapolation of clinical data.…”

Metabolismo miocárdico após cardioplegia sangüínea hipotérmica retrógrada contínua

“…Esta extração aumentou progressivamente, durante a reperfusão, embora, após 60 minutos de reperfusão, ainda fosse significantemente menor do que o controle pré-CEC. Isto pode reforçar a hipó-tese da disfunção metabólica celular, de pelo menos um grupo de células e, provavelmente, ao nível mitocondrial (9,16,23,(29)(30)(31)(32) .…”

Hyperkalemic Blood versus Crystalloid Cardioplegia in Longer Clamping Times

“…16 Another demonstrated that blood and crystalloid cardioplegia were similar regarding lactate metabolism after reperfusion, CK-MB release, and ventricular function. 17 The type of CCP used in these studies varied, making comparison of results difficult. Flack and colleagues 13 comparing CCP and BCP in a multicenter study, did not even differentiate subtypes of CCP.…”