ABSTRACT
We studied 287 consecutive patients who underwent valve replacement procedures under retrograde warm-blood cardioplegia between 1 March 1992 and 30 June 1997 (64 months). Some of the procedures were performed in combination with other operations (70), but most (217) were isolated. Thirty patients had undergone previous "open" procedures and another 25 patients had undergone prior "closed" procedures. The 30-day postoperative mortality rate was 3.8% (11 deaths). In 7 patients, the cause of death was not cardiogenic. We did not observe any instance of right ventricular failure, perforation of the coronary sinus, phrenic nerve palsy, or wound infection. These results indicate that retrograde warm-blood cardioplegia provides excellent myocardial protection of both ventricles during valve replacement.
Subject(s)
Heart Arrest, Induced/methods , Heart Valve Prosthesis Implantation , Myocardial Reperfusion Injury/prevention & control , Adult , Aged , Aged, 80 and over , Aortic Valve , Cardioplegic Solutions , Coronary Artery Bypass/methods , Coronary Artery Bypass/mortality , Female , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis Implantation/mortality , Humans , Male , Middle Aged , Mitral Valve , Morbidity , Postoperative Complications/epidemiology , Reoperation/methods , Survival RateABSTRACT
From 1 March 1992 too 31 July 1993 (17 months), 480 consecutive patients underwent various open-heart procedures under anterograde (83 patients) or retrograde (397 patients) or retrograde (397 patients) continuous warm blood cardioplegia. Some 352 patients (73.3%) had isolated coronary artery bypass grafts (CABG) and 117 (24.3%) had valve replacement either isolated (96) or in combination with other operations (21). Two patients had CABG and ventricular aneurysmectomy, eight had correction of congenital defects, and one had resection of left atrial myxoma. The 30-day postoperative mortality rate was 2.9% (14 deaths). In four patients the cause of death was not cardiogenic. An intra-aortic balloon was used in 11 patients following CABG (3.1%) with six survivors. Perforation of the coronary sinus occurred in one patient. Perioperative myocardial infarction was observed in 5.6% of patients after CABG. No myocardial infarction occurred after valve replacement. Phrenic nerve injury and wound infection were not observed. These results indicate that warm blood cardioplegia, especially when delivered retrogradely, provides excellent myocardial protection of both ventricles during various open-heart procedures.
Subject(s)
Heart Arrest, Induced/methods , Adult , Aged , Aged, 80 and over , Cardiac Surgical Procedures/mortality , Cardioplegic Solutions , Catheterization , Coronary Artery Bypass , Female , Heart Aneurysm/surgery , Heart Defects, Congenital/surgery , Heart Neoplasms/surgery , Heart Valve Prosthesis , Humans , Male , Middle Aged , Postoperative Complications/mortality , TemperatureABSTRACT
The isolated perfused working rat heart model of cardiopulmonary bypass and ischaemic cardiac arrest has been used to investigate whether addition of various organic anti-oxidants to the St Thomas' Hospital cardioplegic solution can enhance the recovery of function of the rat myocardium after normothermic (37 degrees C) global ischaemic arrest. Five anti-oxidants were studied: (i) ascorbate (1.0 and 10.0 mmol.litre-1), (ii) methionine (1.0 and 10.0 mmol.litre-1), (iii) reduced glutathione (1.0 and 10.0 mmol.litre-1), (iv) dimethylthiourea (0.1, 1.0, 10.0 and 50.0 mmol.litre-1), (v) N-2-mercaptopropionyl glycine (0.1, 1.0 and 10.0 mmol.litre-1). The recovery of aortic flow in control hearts which were free of anti-oxidant was 50.7(SEM 0.5)%; ascorbate (1.0 or 10.0 mmol.litre-1) improved this recovery to 72.1(1.7) and 70.2(0.3)% respectively; methionine (1.0 and 10.0 mmol.litre-1) improved the recovery to 74.1(5.7)% and 67.7(1.7)%, respectively; reduced glutathione (1.0 and 10.0 mmol.litre-1) improved the recovery to 66.7(1.4)% and 74.0(1.7)% respectively. In further studies, the addition of dimethylthiourea (0.1, 1.0 and 10.0 mmol.litre-1) to the cardioplegic solution failed to improve recovery of aortic flow [47.3(8.0), 24.6(7.3), 48.0(7.7)% respectively] when compared to its anti-oxidant free control value of 40.4(6.1)% and at a concentration of 50.0 mmol.litre-1 a very poor recovery of aortic flow of 7.7(4.8)% was observed. Mercaptopropionyl glycine (0.1, 1.0 and 10.0 mmol.litre-1) also failed to improve the recovery of aortic flow [34.7(1.6), 34.7(7.7) and 25.6(5.4)% respectively.2+ Since biological membranes are highly permeable to dimethylthiourea and mercaptopropionyl glycine, it is possible that they accumulate in the intracellular compartment.(ABSTRACT TRUNCATED AT 250 WORDS)
