The aim of this work was to question the necessity of repeated administration of warm blood cardioplegia in modern cardiac surgery. A consecutive series of 4014 patients underwent cardiosurgical procedures in the period from January 2001 to December 2006 in our centre, where modified Calafiore warm blood-cardioplegic solution was used. 1708 patients received a single shot of cardioplegia instead of repeated blood cardioplegia (every 20 min). A multivariate analysis was performed using logistic regression models to reveal the statistical significance of the effect of single-shot cardioplegia on the occurrence of: death, intraoperative need of inotropics, intraoperative intra-aortic balloon pump (IABP), postoperative infarction, arrhythmia, postoperative need for inotropics and postoperative IABP. The results showed statistical insignificance concerning mortality (P=0.704), intraoperative IABP (P=0.247), postoperative inotropics (P=0.273), postoperative IABP (P=0.678), postoperative arrhythmia (P=0.661). Single-shot cardioplegia showed a positive effect concerning postoperative myocardial infarction (P=0.003). However, it showed an unfavourable effect concerning intraoperative inotropics (P=0.038) and postoperative dialysis (P=0.015). The clinical safety of the first shot of warm blood cardioplegia might be exceeding 20 min. In the light of increasingly short cross-clamping time, the safety of the first shot might be long enough to cover the whole cross-clamping time.
doi:10.1510/icvts.2008.192757B1 First of all, we would like to thank Professor Bockeria for his interest in our article and for his comments. The following is our contribution to the topic. 1. We realise that our analysis did not come out with a clear statement of the suggested interval between re-infusions, but the main target of our analysis was to find out if the first shot of warm cardioplegia might cover)20 min safely. As our results confirmed that w1x, our next step will be to try to specify the time frame between re-infusions, within which adequate myocardial protection can be achieved. This work is already in progress and we hope we will be able to publish its primary results this year. 2. We understand the concerns of Professor Bockeria regarding our short cross-clamping time. We would like to reassure him that our message was not to operate faster. However, being able to perform complete procedures within a short cross-clamping time enabled us to use a single shot of cardioplegia, and that is what made us question the 15-min interval state
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