Tepid antegrade intermittent blood cardioplegia as an alternative for intermittent crossclamping with Lidoflazine

Sofia Kalantary, Anouk de Bruyn, Steven Laga, Inez Rodrigus

Department of Cardiac Surgery, Antwerp University Hospital, Antwerp, Belgium.
University of Antwerp, Antwerp, Belgium.

DOI: 10.4236/wjcd.2013.37071                

Abstract

Background: Blood cardioplegia is a technique with many variations in its use. Intermittent cross clamping with Lidoflazine has proven to deliver good cardioprotection in our center. Question: Is tepid (32°C) antegrade intermittent blood cardioplegia an efficient, safe and easy-to-use alternative to intermittent cross-clamping with Lidoflazine in elective isolated CABG in low-risk patients? Primary outcomes are heart enzymes (cTnI, CK-MB). Secondary outcomes are operation times, length of hospital stay, major complications and in-hospital mortality. Methods: From January 2012 until November 2012, 40 patients with LVEF ≥50%, EuroSCORE II <3.5% and no severe systemic disease underwent elective CABG and were consecutively randomized to intermittent cross-clamping (ICC; n = 20) or blood cardioplegia (BCP; n = 20). All were operated on by the same surgeon. Results: There were no significant differences in age (BCP 65.34 ± 9.76; ICC 65.25 ± 8.42) and EuroSCORE II (BCP 1.25 ± 0.72; ICC 1.04 ± 0.71). There was a significant difference in cross clamp time (BCP 61.10 ± 23.07; ICC 41.30 ± 13.10). No significant differences in ECC-time (BCP 95.85 ± 27.04; ICC 113.80 ± 34.47) and number of distal anastomoses (BCP 2.70 ± 0.73; ICC 2.90 ± 0.72) were found. Values of cTnI 1-day postoperative (BCP 1.50 ± 0.76; ICC 4.50 ± 3.90), maximum cTnI (BCP 2.85 ± 1.73; ICC 6.40 ± 4.30) and maximum CK-MB (BCP 21.10 ± 22.30; ICC 31.35 ± 24.39) differed significantly. No significant differences in postoperative parameters were found: length of hospital stay (BCP 7.95 ± 1.40; ICC 8.25 ± 1.71), atrial fibrillation (BCP 0.20 ± 0.41; ICC 0.45 ± 0.51), major complications (BCP 0.35 ± 0.49; ICC 0.30 ± 0.47). There was no in-hospital mortality. Conclusion: Primary outcomes defined by the cardiac enzymes (cTnI, CK-MB) favour the use of tepid antegrade intermittent blood cardioplegia in low-risk patients undergoing elective CABG-operations. Regarding secondary outcomes, ICC showed shorter cross clamp times.

Keywords

Blood Cardioplegia; Intermittent Cross Clamping; Lidoflazine; Myocardial Protection

Conflicts of Interest

The authors declare no conflicts of interest.

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