Intermittent ischaemic arrest and cardioplegia in coronary artery surgery: coming full circle?

Taggart, David P.; Bhusari, Sudhir; Hopper, James; Kemp, Michael; Magee, P; Wright, J E; Walesby, R.K.

doi:10.1136/hrt.72.2.136

Cited by 30 publications

(16 citation statements)

References 23 publications

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“…Since 1982, there have been a number of clinical trials comparing cardioplegia with ischemic arrest in a prospective randomized manner. 3,4,[9][10][11][12] None showed significant superiority of cardioplegia over intermittent ischemic fibrillatory arrest.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Surgery without Cardioplegia: Early Results

Wong

Vendargon

Lim

2000

Asian Cardiovasc Thorac Ann

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From November 1996 to April 1999 patients underwent isolated noncardioplegic coronary artery bypass grafting at a new center. There were 123 (35%) patients aged over 60 years, 48 (14%) were female, 70 (20%) had a left ventricular ejection fraction below 0.3. Coronary artery bypass graft surgery was performed using hypothermic intermittent ischemic fibrillatory arrest of the heart. The left internal mammary artery was used in 97% of cases. Mean grafts per patient was 3.5. Sixty-three patients (18%) underwent 65 coronary endarterectomies. The overall operative mortality rate was 2.3% (8/348). Follow-up was 97% complete. Mean follow-up was 14.9 ± 8 months (range, 1 to 30 months). Freedom from angina was 98.3% at 6 months, 97% at 12 months, and 97% at 24 months. The overall survival was 96.7% at 6 months, 95.8% at 12 months, and 94.4% at 24 months. It was concluded that this method of myocardial protection for isolated coronary artery bypass graft surgery provided excellent operating conditions in this group of patients.

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Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Surgery without Cardioplegia: Early Results

Wong

Vendargon

Lim

2000

Asian Cardiovasc Thorac Ann

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Section: Timementioning

confidence: 99%

“…conducted a similar study with 20 patients in a prospective randomized trial comparing these two methods [14] . In this study, the duration of ischemia was (30 min and 32 min for CCA and IAC respectively) very similar to our study (31.6 min and 24.6 min for CCA and IAC groups, respectively) and they found that troponin T showed similar levels throughout postoperative 72 hours in both groups [14] . Cohen et al examined a small cohort of 24 consecutive CABG patients in a prospective randomized trial which compared these two techniques and levels of troponin T did not differ between the two groups, indicating similar protective properties [15] .…”

Section: Timementioning

confidence: 99%

Comparison of Myocardial Metabolism and Apoptosis in Patients Undergoing CABG Operation Performed Either with Fibrillation or Cardioplegia Method

Yazıcıoğlu¹,

Parlar²,

Tokat³

et al. 2020

GKDA Derg

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Objective: Optimal myocardial protection during CABG operations is still debatable. In this study we compared hemodynamic data, myocardial oxygen extraction, lactate production and presence of apoptosis in transmural biopsy specimens in operations performed either with intermittent aortic cross-clamping with fibrillation (IAC) or with cardioplegic cardiac arrest (CCA) method. Methods: Following Ethics Committee approval, consecutive patients with normal ventricular function and without any comorbid disease other than regulated hypertension and/or type-2 DM were included in the study (IAC group n=13, CCA group n=8). Hemodynamic data, serial CK-MB values and ECG changes at intermittent time points were recorded till postoperative 24 hours. Myocardial oxygen extraction and lactate production were calculated from the blood samples withdrawn from the aortic root and the coronary sinus cannula before total CPB, during cross-clamping and following removal of cross-clamp. Transmural biopsy specimens obtained before total CPB and cessation of CPB were analyzed for apoptosis. Results: Demographic and intraoperative hemodynamic variables were similar. Pre ischemic and post ischemic myocardial oxygen extraction and lactate production values were comparable in both groups. Seven patients in IAC and one patient in CCA group needed low dose inotropic support during early postoperative period. Any evidence of apopitosis was not found in both groups. Conclusion:This study shows that for low risk CABG procedures, IAC and CCA methods were not superior to each other in protecting the myocardium from ischemic injury with respect to myocardial oxygen extraction, lactate production and presence of apoptosis.

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“…1 Several studies have shown fibrillation to be as safe or safer than cardioplegic arrest, through preconditioning. [2][3][4][5][6] Exponents of fibrillation claim that the technique is simpler, allows the myocardium to be reperfused during the procedure, and potentially shortens ischemic and cardiopulmonary bypass (CPB) times. 2 However, fibrillation is associated with more handling and repeated clamping of the aorta.…”

Section: Introductionmentioning

confidence: 99%

“…17, NO. 3 ASIAN CARDIOVASCULAR & THORACIC ANNALS major role in neuropsychological changes after CABG. 11 Neuropsychological decline occurs in up to 79% of patients within 5 days of surgery, 18.5%-40% at 6-8 weeks, and 7%-57% at 6 months.…”

Section: Introductionmentioning

confidence: 99%

Effect on the Brain of Two Techniques of Myocardial Protection

Stygall

Suvarna

Harrington

et al. 2009

Asian Cardiovasc Thorac Ann

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This study compared the occurrence of intraoperative microemboli and postoperative changes in neuropsychological performance in 195 patients undergoing coronary artery bypass grafting who were randomized to intermittent crossclamp fibrillation or cardioplegic arrest. Cerebral microemboli were recorded from cannulation to 15 min after decannulation, using transcranial Doppler in 166 patients. Microemboli in relation to 9 surgical events were also noted. Neuropsychological change scores were obtained by comparing cognitive performance preoperatively with that at 6-8 weeks after surgery. The median number of microemboli detected was 105 (range, 9-1,757) in the fibrillation group, and 110 (range, 1-1,306) in the cardioplegia group, with no significant difference between groups. There was also no significant difference between groups in the generation of microemboli during any of the surgical events. Neuropsychological tests were completed postoperatively by 177 participants, with no significant differences in performance found between the 2 groups. Given the equivalence of the effect of intermittent crossclamp fibrillation and cardioplegic arrest on microemboli and neuropsychology, consideration of which form of myocardial protection to employ should perhaps focus more on which method affords most protection to the heart.

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Intermittent ischaemic arrest and cardioplegia in coronary artery surgery: coming full circle?

Cited by 30 publications

References 23 publications

Coronary Artery Bypass Surgery without Cardioplegia: Early Results

Coronary Artery Bypass Surgery without Cardioplegia: Early Results

Comparison of Myocardial Metabolism and Apoptosis in Patients Undergoing CABG Operation Performed Either with Fibrillation or Cardioplegia Method

Effect on the Brain of Two Techniques of Myocardial Protection

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