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J Thorac Cardiovasc Surg 2000;119:610-616
© 2000 Mosby, Inc.
CARDIOPULMONARY SUPPORT AND PHYSIOLOGY |
From the Departments of Thoracic and Cardiovascular Surgery,a Pharmacology,b and Biostatistics,c Saint-Jacques Hospital, Besançon, France.
Address for reprints: Sidney Chocron, MD, Department of Thoracic and Cardiovascular Surgery, Hopital Jean Minjoz, Besançon, France 25030 (E-mail: chocron{at}usa.net ).
Background: In the field of intermittent antegrade blood cardioplegia, 3 levels of temperature are commonly used: (1) cold (8°C); (2) tepid (29°C); and (3) warm (37°C). Given the 21°C spread and the metabolic changes that can occur between cold (8°C) and tepid (29°C) cardioplegia, we thought it worthwhile to test a temperature halfway between the cold and tepid levels. The aim of this study was to test the quality of myocardial protection provided by intermediate lukewarm (20°C) cardioplegia by comparing it with cold and warm cardioplegia. Protection was assessed by measuring cardiac troponin I release.
Methods: One hundred thirty-five patients undergoing coronary artery bypass grafting were enrolled in a prospective randomized trial comparing cold (8°C), intermediate lukewarm (20°C), and warm (37°C) antegrade intermittent blood cardioplegia. Cardiac troponin I concentrations were measured in serial venous blood samples.
Results: The total amount of cardiac troponin I released was significantly higher in the cold group (4.7 ± 2.3 µg) than in the intermediate lukewarm (3.4 ± 2.0 µg) or the warm (3.1 ± 2.7 µg) groups. The cardiac troponin I concentration was significantly higher at hour 6 in the intermediate lukewarm group (1.23 ± 0.55 µg/L) than in the warm group (0.89 ± 0.50 µg/L).
Conclusions: Intermittent antegrade intermediate lukewarm blood cardioplegia is appropriate and clinically safe. Cardiac troponin I release suggests that intermediate lukewarm cardioplegia is better than cold cardioplegia but less effective than warm cardioplegia in low-risk patients. We therefore recommend the use of warm cardioplegia in low-risk patients.
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