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3 . 2022

Analysis of the use of cold crystalloid cardioplegia and own modification of warm, low-volume blood cardioplegia in coronary artery bypass surgery in patients with poor myocardial reserve

Abstract

Aim – to compare the effectiveness of using our own modification of blood, warm, low-volume, single-dose and cold crystalloid cardioplegia with NTC-solution in isolated primary coronary artery bypass grafting in adult patients with poor myocardial reserve and LVEF <35%.

Material and methods. The study was based on a single-center analysis of data from 199 adult patients with LV ejection fraction <35%, aged 35–76 years, who underwent primary planned aortocoronary bypass grafting under cardiopulmonary bypass in the period from 2015 to 2020. Depending on the method of myocardial protection, patients were randomized into two groups: a group that used its own modification of a thermal blood low-volume single-dose CP (blood CP) – 120 patients and a group of pharmaco-cold crystalloid CP with NTK-solution (crystalloid CP) – 79 patients.

Results. All patients had multivessel occlusive stenotic lesions of the coronary bed with comparable values on the scale (Syntax SCORE, p=0.8), revascularization index of 2 or more, and received CABG. The duration of the periods of MI did not differ. In the group with blood CP, a significantly smaller volume of CP was required (p<0.001) in all patients (p<0.001), the main mechanism for the asystole during the induction of cardioplegia was AV blockade. In the crystalloid CP group, induction of cardioplegic solution resulted in 84% cardiac arrest due to ventricular fibrillation (p<0.001). After removal clamp from the aorta in the blood CP group, spontaneous recovery of cardiac activity was observed in 93.3% (112 patients) versus 41% (32 patients) in the crystalloid CP group (p=0.001), the need for defibrillation, respectively, 6% of cases versus 32% (p=0.03). The need for cardiotonic and/or vasopressor support >24 hours, enzymatic response (increase in CK, CK-MB, Troponin T) were higher in the crystalloid CP group. The incidence of MI, low output cardiac syndrome, AF, stroke, abdominal complications, hospital mortality had no differences. The blood CP group demonstrated lower mortality during the year (p<0.001).

Conclusion. The proposed own modification of low-volume, blood cardioplegia is a reliable way to protect the myocardium during coronary artery bypass surgery in patients with poor myocardial reserve (LV EF <35%).

Keywords:low left ventricular ejection fraction; myocardial protection

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Basylev V.V., Evdokimov M.E., Pantyuhina M.A. Analysis of the use of cold crystalloid cardioplegia and own modification of warm, low-volume blood cardioplegia in coronary artery bypass surgery in patients with poor myocardial reserve. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (3): 48–58. DOI: https://doi.org/10.33029/2308-1198-2022-10-3-48-58  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)
Вскрытие
Medicine today

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