The effects of cardioplegic potassium concentration and myocardial temperature on electrical activity in the heart during elective cardioplegic arrest

Tb, Ferguson; Pk, Smith; Gk, Lofland; Wl, Holman; Ma, Helms; Jl, Cox

doi:10.1016/s0022-5223(19)35879-9

Cited by 19 publications

(2 citation statements)

References 21 publications

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“…Cold blood cardioplegia (CBCP) has been an important strategy to minimize intraoperative myocardial injury and continues to be in widespread use [ 1 – 5 ], although some controversies remain about cold versus warm [ 9 – 11 ], blood versus crystalloid [ 12 – 14 ], antegrade versus retrograde [ 12 , 15 , 16 ], and intermittent versus continuous delivery [ 9 ]. The underlying rationale of CBCP is that during ischemic arrest, hypothermia further reduces myocardial metabolism, and oxygenated blood provides optimal buffering capacity.…”

Section: Discussionmentioning

confidence: 99%

Analysis of myocardial temperature changes in conventional isolated coronary artery bypass grafting

Okamoto

Tamenishi

Nishi

et al. 2014

Gen Thorac Cardiovasc Surg

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Backgrounds To determine whether cold blood cardioplegia (CBCP) can get over coronary artery lesions, we analyzed the relationship between myocardial temperature changes and lesion severity of major coronary arteries.Methods and resultsFrom April 1991 to October 2003, we measured myocardial temperature before and after antegrade and retrograde delivery of CBCP in 492 patients undergoing conventional coronary artery bypass grafting. Stenotic severity of three major coronary arteries was classified into four grades according to preoperative coronary arteriography; grade 0 for 50 % or less, 1 for 75 %, 2 for 90 %, 3 for 99 % or 100 %. We analyzed relationships between myocardial temperature changes [ΔT-A (antegrade) & ΔT-R (retrograde)] and the coronary artery lesion’s severity. Average ΔT-A of the right coronary artery had no relationship with stenotic grades. Mean ΔT-A of the left anterior descending (LAD) became less and less in proportion to its stenotic grade [9.7 °C for grade 0, 8.2 °C for grade 1, 7.1 °C for grade 2, and 6.0 °C for grade 3, respectively, (p = 0.0042)]. ΔT-A of the circumflex artery showed similar but weaker tendency than those of LAD. Significant inverse correlations were found between ΔT-A and ΔT-R1 in each territory (p < 0.001).ConclusionsAntegrade delivery was less effective in situations with tight proximal lesion, especially in the LAD territory. Retrograde delivery supplemented antegrade delivery. Myocardial temperature monitoring enables us to deal with inadequate cardioplegic delivery, and is a good indicator of myocardial protection.

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Section: Discussionmentioning

confidence: 99%

Analysis of myocardial temperature changes in conventional isolated coronary artery bypass grafting

Okamoto

Tamenishi

Nishi

et al. 2014

Gen Thorac Cardiovasc Surg

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“…Thus, warm blood cardioplegia should have a protective effect on the postoperative conduction disturbances. Use of a combined antegrade/retrograde approach, resulting in a more homogeneous distribution of cardioplegia, is associated with lower incidence of postoperative conduction disturbances, 20,27,30,35 as is moderately high potassium concentrations (about 15 mEq/L) in crystalloid cardioplegia solutions 4,36–39 . This is probably due to the fact that in high doses, potassium produces a rapid diastolic arrest by depolarization of the cardiac membrane, with resultant preservation of high‐energy phosphates during the period of ischemic arrest, and thereby a normal recovery of cardiac function following resumption of normal coronary flow.…”

Section: Pathogenesismentioning

confidence: 99%

Fascicular Conduction Disturbances After Coronary Artery Bypass Surgery: A Review With a Meta-Analysis of Their Long-term Significance

et al. 2006

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Fascicular conduction abnormalities are frequently reported following adult cardiac surgery, but their pathogenesis and long-term outcomes remain unclear. In this article, we review the epidemiological features, pathogenesis, diagnosis, and management, and the short-term and long-term significance of fascicular conduction abnormalities following coronary artery bypass graft (CABG) surgery, based on data from 30 studies. Conduction disturbances have an incidence of 3.4% to 55.8% after CABG surgery, the most common being right bundle branch block (RBBB). RBBB is usually transient and benign. Although a slew of factors have been implicated in the pathogenesis of fascicular conduction disturbances, the two most important factors are myocardial ischemia and type of cardioplegia. While a 12-lead electrocardiogram is the gold standard for diagnosis, additional tests such as myocardial enzymes or echocardiography may have additional diagnostic and prognostic value. Short-term prognosis after RBBB is good, but its impact on long-term survival is unclear. We conducted a meta-analysis, the first of its kind in this area, using long-term survival data from five studies. There was no difference in long-term survival between patients who developed conduction disturbances after CABG surgery, and those who did not, indicating a benign influence of conduction disturbances on long-term survival, and the lack of the necessity for monitoring or pacing. While the older literature reported an adverse impact of fascicular conduction disturbances on long-term survival, the more recent studies report a substantially reduced mortality after CABG surgery, despite a higher incidence of conduction disturbances, pointing to the effect of improved surgical techniques.

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The Myocardium: Physiology and Protection During Cardiac Surgery and Cardiopulmonary Bypass

Guyton¹

1995

Cardiopulmonary Bypass

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The effects of cardioplegic potassium concentration and myocardial temperature on electrical activity in the heart during elective cardioplegic arrest

Cited by 19 publications

References 21 publications

Analysis of myocardial temperature changes in conventional isolated coronary artery bypass grafting

Analysis of myocardial temperature changes in conventional isolated coronary artery bypass grafting

Fascicular Conduction Disturbances After Coronary Artery Bypass Surgery: A Review With a Meta-Analysis of Their Long-term Significance

The Myocardium: Physiology and Protection During Cardiac Surgery and Cardiopulmonary Bypass

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