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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 45-51, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
H Matsuura, HL Lazar, X Yang, S Rivers, P Treanor, S Bernard and RJ Shemin
This experimental study sought to compare the effectiveness of warm blood
cardioplegia versus cold blood cardioplegia in protecting areas of ischemic
myocardium during urgent coronary revascularization. In 40 adult pigs, the
second and third diagonal vessels were occluded with snares for 90 minutes.
All animals were then placed on cardiopulmonary bypass and underwent 45
minutes of cardioplegic arrest followed by 3 hours of reperfusion during
which time the coronary snares were released. During the period of
cardioplegic arrest, 10 pigs received antegrade continuous warm blood
cardioplegic solution (37 degrees C) at 100 ml/min; 10 animals received
retrograde warm blood cardioplegic solution at 100 ml/min; 10 received
intermittent, antegrade cold blood cardioplegic solution (4 degrees C), and
10 animals received intermittent, antegrade/retrograde cold blood
cardioplegic solution. Hearts protected with antegrade warm blood
cardioplegic solution had the lowest pH values in the area at risk (6.59
+/- 0.10 antegrade warm blood cardioplegia versus 6.80 +/- 0.10 retrograde
warm blood cardioplegia versus 6.72 +/- 0.18 antegrade cold blood
cardioplegia versus 6.85 +/- 0.15 antegrade/retrograde cold blood
cardioplegia and the highest area of necrosis (42% +/- 3% antegrade warm
blood cardioplegia versus 26% +/- 2% [p < 0.05 from antegrade warm blood
cardioplegia] retrograde warm blood cardioplegia versus 31% +/- 2% [p <
0.05 from antegrade warm blood cardioplegia] antegrade cold blood
cardioplegia versus 21% +/- 2% [p < 0.05 from antegrade warm blood
cardioplegia] antegrade/retrograde cold blood cardioplegia). We conclude
that in the presence of an acute coronary occlusion with ischemic
myocardium, warm blood cardioplegic solution should be given in a
continuous retrograde fashion and does not result in myocardial protection
superior to the protection that can be achieved with antegrade/retrograde
cold blood cardioplegic solution.
ARTICLES
Warm versus cold blood cardioplegia--is there a difference?
Department of Cardiothoracic Surgery, Boston University Medical Center, Mass.
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