Antegrade and retrograde cardioplegia with different reperfusion techniques in patients with multiple coronary artery lesions.

To evaluate the effectiveness of retrograde cardioplegia and reperfusion, a total of 266 patients undergoing coronary bypass surgery between Nov 1987 to Dec 1989 were divided into three groups depending on the method of cardioplegic fluid delivery and reperfusion. In group I (80 patients) antegrade cardioplegia and reperfusion was used. In group II (98 patients) antegrade and retrograde cardioplegia and antegrade reperfusion was used while in group III antegrade and retrograde cardioplegia and retrograde reperfusion was used. Myocardial functions were studied with the help of an on-line computer on the basis of mathematical model of heart before and after cardiopulmonary bypass. Biopsy specimens were collected before, during and after cardiopulmonary bypass in order to study myocardial structural changes. In group I patients there was decrease in myocardial function in the immediate post perfusion period while group II patients had considerable improvement in their myocardial function and groups III patients showed further improvement in it. Ultrastructural myocardial study revealed considerable detrimental changes in group I, minimal changes in group II and no change in group III patients. Thus in our experience retrograde cardioplegia and retrograde reperfusion with warm oxygenated blood provide maximum myocardial protection in patients with multiple coronary artery lesions.

[The risk of neurological complications following aortocoronary bypass in patients with multifocal atherosclerosis]. / Risk nevrologicheskikh oslozhnenii posle aortokoronarnogo shuntirovaniia u bol'nykh s mul'tifokal'nym aterosklerozom.

Since January 1988 till June 1990 145 patients with combined coronary and vascular pathology have been operated on. Concomitant damage of aortic arch branches was observed in 54 patients (37.2%), and aortocoronary bypass surgery was performed in 40 patients without correction of the carotid vascular bed pathology. These patients comprised the basic group, which was divided into two subgroups depending on the clinical pattern of the disease: subgroup I--18 asymptomatic patients (45.0%), subgroup II--22 patients (55.0%) with clinical signs of the disease. The basic group comprised 257 patients with CHD alone and no damages of the aortic arch branches. In the postoperative period 10 out of 40 patients of the basic group developed neurological complications: brain hypoxia, delirious syndrome (3 patients); brain hypoxia, pre-comatose condition (3 patients); brain hypoxia, comatose condition (2 patients); transitory ischemic attack (2 patients). No significant differences in the development of complications have been observed in patients of both subgroups. In the control group neurological complications developed in 9 out of 257 patients (3.5%). The comparison of reasons responsible for the onset of complications in both groups has shown that acute heart failure was significantly predominant (10%) in the basic group, as compared to control group (1.9%). It has been concluded that after aortocoronary bypass surgery the risk of neurological complications was higher in patients with the accompanying damage of the aortic arch branches than in patients with CHD alone; the onset of acute heart failure in the early postoperative period increases the risk of neurological complications in such patients.

[An initial experience of extracorporeal irradiation of the blood in heart surgery patients]. / Pervyi opyt ékstrakorporal'nogo oblucheniia krovi u kardiokhirurgicheskikh bol'nykh.

Ultraviolet (UV) blood irradiation has been performed in 11 patients with postoperative sepsis. UV blood irradiation was not accompanied by blood cell damage and stress reaction to irradiation. Already after the first session all the patients demonstrated a decrease in the maximum daily body temperature. Most patients revealed improvement in their somatic condition. Positive clinical effect was observed in 8 patients, 4 patients recovered completely. UV blood irradiation in combination with conventional therapeutic techniques may be used in the management of postoperative septic complications in cardiosurgical patients.

[Changes in hemodynamic indices during perfusion with pulsatile and steady currents in aortocoronary bypass surgery]. / Izmenenie pokazatelei gemodinamiki pri perfuzii s pul'siruiushchim i postoiannym potokami vo vremia operatsii aortokoronarnogo shuntirovaniia.

Hemodynamic parameters were compared in 28 patients with ischemic heart disease subject to cardiopulmonary bypass surgery with non-pulsatile (group 1) and pulsatile flow (group 2). Systolic, diastolic and mean blood pressure (MBP) was assessed, total peripheral vascular resistance (TPVR) was calculated, esophageal, rectal and skin temperature was measured. Volumetric perfusion rate was the same in both groups. Pulse pressure was maintained at the level of 35 mmHg. MBP at the stage of hypothermia plateau and during warming decreased in both groups. It was significantly lower in group 1 at the beginning of warming and during clamp relief from the aorta. At the end of cooling period TPVR was lower with the use of pulsatile than non-pulsatile flow. It increased drastically towards the end of hypothermia plateau in group 1. During clamp relief from the aorta TPVR values did not significantly differ from baseline in group 2 and remained high in group 1. The warming rate happened to be greater in pulsatile than in non-pulsatile flow.