Warm blood cardioplegia

Vaughn, Cecil C.; Opie, John C.; Florendo, Federico T.; Lowell, Patricia; Austin, Jon W

doi:10.1016/0003-4975(93)90039-k

Cited by 41 publications

(9 citation statements)

References 11 publications

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“…Yau and his associates found that blood loss was significantly greater in patients having hypothermic bypass compared to patients who underwent normothermic bypass (32) . The same findings were encountered also by Vaughn and coworker, they reported 20% reduction in daily blood loss in patients in whom normothermic bypass was used compared to those in whom hypothermic cardiopulmonary bypass was used (33) .…”

Section: Effortssupporting

confidence: 80%

Warm Versus Cold Intermittent Blood Cardioplegia for Myocardial Protection During on-Pump Coronary Artery Bypass Grafting

Hassouna

Aziz

Amar

et al. 2020

Ain Shams Medical Journal

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Background: Obtaining an optimal surgical result depends on performing a technically proficient operation while protecting the heart from potential damage. Cardioplegia is an essential component in myocardial protection during aortic cross-clamping and cardiopulmonary bypass. The development of cardioplegia solutions is one of the major advances in cardiac surgery that allowed surgeons to extend the period of ischemic arrest to well over 3 hours to perform complex surgical procedures without adversely affecting myocardial functio). Aim of the work: We sought to compare between two specific modalities of myocardial protection using either intermittent antegrade cold blood cardioplegia or warm blood cardioplegia. Patients and Methods: This prospective study included 200 successive adult patients who have undergone elective on-pump coronary artery bypass grafting (CABG) operations. Randomization was done immediately before the beginning of the operation so that group allocation was blinded to the patient. Participants were recruited between 14 January 2017 and 10 July 2019 at Mahalla Cardiac Center. All patients were thoroughly evaluated preoperatively, intraoperatively, and postoperatively. Results: There was no statistically significant difference between the two groups as regards bypass and cross clamp times. However, there was a statistically significant difference between the two groups as regards spontaneous defibrillation. There were no significant differences in both groups regarding the needed either inotropic support, or an IABP to achieve weaning. The total period of mechanical ventilation was statistically shorter in the warm group compared to the cold group. Conclusion: We found that there was no difference in the clinical effect of warm or cold blood cardioplegia despite the relative increase in postoperative serum cTnI in the warm cardioplegia group. Both strategies appear to allow a comparable and satisfactory method for myocardial protection during the period of cardiac arrest.

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Section: Effortssupporting

confidence: 80%

Warm Versus Cold Intermittent Blood Cardioplegia for Myocardial Protection During on-Pump Coronary Artery Bypass Grafting

Hassouna

Aziz

Amar

et al. 2020

Ain Shams Medical Journal

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“…Yau and his associates found that blood loss was significantly higher in patients with hypothermic bypass compared to patients who underwent normothermic bypass (29). Vaughn and coworker also found the same results, reporting a 20 percent decrease in daily blood loss in patients using normothermic bypass compared with those using hypothermic cardiopulmonary bypass (28).…”

Section: Postoperative and Discharge Datamentioning

confidence: 81%

Comparison Study: Intermittent Antigrade Warm Cardioplegia Versus Antigrade Cold Intermittent Blood Cardioplegia for Myocardial Protection During Elective on Pump Coronary Artery Bypass Grafting in Early Post-Operative Period

El-Safty¹,

ijar²,

Bakr³

et al. 2020

IJAR

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Background: Defending the heart against potential damage during cross-clamping is the most important and vital step to ensuring a successful surgical outcome(1). The creation of cardioplegia solutions was one of the major advances in cardiac surgery that allowed surgeons to conduct complicated surgical procedures to avoid myocardial injury (14). Treating cardioplegia at a cool temperature would be a significant factor in lowering myocardial metabolism. However, the reduction in myocardial metabolism due to hypothermia, compared with that achieved by diastolic arrest, is usually very negligible. Since Normothermias enzymatic and cellular processes work better (7). Owing to the propensity of the heart to resume electrical operation during normothermia, however, this must be administered consistently or only with short interruptions (4). Terminal warm blood cardioplegia (hot shot) is normally done just before the elimination of the aortic cross-clamp since it has been demonstrated that myocardial metabolism is increasing (23). Methods: A prospective controlled randomised study (200 hundred patients aged 40 to 65 years of both sexes underwent elective CABG pump surgery) will be included. They will be divided into three groups of patients: Group I:includes 100 Patients who received intermittent cold blood cardioplegia. Group II:includes 100 Patients who received intermittent warm blood cardioplegia with controlled reperfusion for 3 minutes before aortic unclamping. Study made from January, 2019 to August, 2020, at National Heart Institute.All patients were thoroughly evaluated preoperatively, intraoperatively, and postoperatively. Results: We hypothesized that in our patient cohort, warm blood cardioplegia could be as successful as or even better than the conventional antegrade cold blood cardioplegia. Patients were randomised into two similar blocks, each of which consisted of 100 patients, each of whom obtained one of the two cardioplegic solutions. Our analysis did not indicate a statistically important difference in the post-operative release of myocardial biomarkers (Troponin I) & CK in both classes. This finding did not significantly reflect the clinical outcome of our patient, which may indicate similar myocardial protection in primary low-risk CABG patients for both cold and warm blood cardioplegia. Conclusion: During the time of cardiac arrest, both methods tend to enable an equal and adequate approach for myocardial defence. To attain improved myocardial defence, warm blood cardioplegia needs a shorter administration interval. Therefore, the choice between one type of cardioplegia and the other remains at the discretion of the surgeon. The statistically minor variation found in the release of myocardial enzymes did not translate into distinct clinical results.

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“…The study of Martin et al identified an approximately threefold increase in cerebral vascular accidents with normothermic CPB [2]. Two other prospective, nonrandomized but consecutive historical control studies reported no change in the incidence of postoperative neurological dysfunction with normothermic CPB compared to hypothermic CPB (warm 1.0% ~s cold 1.3%, warm 0.8% vs cold 1.0%, respectively) [10,11]. Differences in these two studies that may have affected the results include differences in technique and patient populations in the management of temperature during normothermic CPB.…”

Section: Discussionmentioning

confidence: 99%

Normothermic cardiopulmonary bypass: effect on the incidence of persistent postoperative neurological dysfunction following coronary artery bypass graft surgery

et al. 1997

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We retrospectively reviewed the records of 250 consecutive patients undergoing coronary artery bypass graft surgery (CABG) from January 1994 through January 1996 to determine the incidence of persistent postoperative neurological dysfunction after CABG and to compare normothermic and moderate hypothermic cardiopulmonary bypass (CPB). Normothermic CPB was used in 128 patients (36°-37°C) and hypothermic CPB (27°-28°C) in 122 patients. Postoperative neurological dysfunction included focal motor deficits, delayed recovery of consciousness (>24h) after surgery, and seizures within 1 week postoperatively. Persistent neurological dysfunction was diagnosed if complete resolution had not occurred within 10 days of surgery. The incidence of persistent postoperative neurological dysfunction was 4.1% in the hypothermic CPB group and 2.3% in the normothermic CPB group. There were no statistically significant differences between the two groups (P=NS). These results suggest that normothermic CPB did not increase the incidence of persistent postoperative neurological dysfunction compared to hypothermic CPB.

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Warm blood cardioplegia

Cited by 41 publications

References 11 publications

Warm Versus Cold Intermittent Blood Cardioplegia for Myocardial Protection During on-Pump Coronary Artery Bypass Grafting

Warm Versus Cold Intermittent Blood Cardioplegia for Myocardial Protection During on-Pump Coronary Artery Bypass Grafting

Comparison Study: Intermittent Antigrade Warm Cardioplegia Versus Antigrade Cold Intermittent Blood Cardioplegia for Myocardial Protection During Elective on Pump Coronary Artery Bypass Grafting in Early Post-Operative Period

Normothermic cardiopulmonary bypass: effect on the incidence of persistent postoperative neurological dysfunction following coronary artery bypass graft surgery

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