Continuous cold blood cardioplegia improves myocardial protection: a prospective randomized study Yves A.G Louagie, MD, PhD, Jacques Jamart, MD, Manuel.

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Copyright © 2008 Thomson Delmar Learning CHAPTER 15 Hemodynamic Measurements.

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Continuous cold blood cardioplegia improves myocardial protection: a prospective randomized study Yves A.G Louagie, MD, PhD, Jacques Jamart, MD, Manuel Gonzalez, MD, Edith Collard, MD, Serge Broka, MD, Laurence Galanti, MD, PhD, André Gruslin, MS The Annals of Thoracic Surgery Volume 77, Issue 2, Pages 664-671 (February 2004) DOI: 10.1016/S0003-4975(03)01522-4

Fig 1 Cardioplegia was assessed by measurement of (top) septal temperature and coronary sinus pressure (bottom). Bolus n represents the averaged data obtained during 250 mL/min infusion of cold blood cardioplegia every 20 minutes. Interval (Interv) n represents the averaged data measured during the intervals used to realize the distal anastomoses. During cardioplegic arrest, the mean septal temperature trending was higher in the intermittent group (p < 0.001). The coronary sinus pressure trending was lower in the intermittent group (p = 0.003). —■— = continuous; – – ▴ – – = intermittent. The Annals of Thoracic Surgery 2004 77, 664-671DOI: (10.1016/S0003-4975(03)01522-4)

Fig 2 Trend in (top) cardiac index and right ventricular ejection fraction (bottom). The procedure time (Proc.) is represented by a hatched bar. The other time intervals represent hours following the end of cardiopulmonary bypass. There was no significant difference between the groups. Student's posthoc t test revealed a p value of 0.04 at 3 hours for cardiac index (asterisk). —■— = continuous; – – ▴ – – = intermittent. The Annals of Thoracic Surgery 2004 77, 664-671DOI: (10.1016/S0003-4975(03)01522-4)

Fig 3 Trend in mean AP, LVSWI, SVR, and PCWP. The procedure time (Proc.) is represented by a hatched bar. The other time intervals represent hours following the end of cardiopulmonary bypass. The LVSWI was significantly better (p = 0.038) in the continuous cardioplegia group of patients by generalized estimating equation analysis. Student's t tests were significantly different at times 12 hours and 24 hours (p = 0.032 and 0.050, respectively, asterisk). The other variables did not differ significantly. —■— = continuous cardioplegia; – – ▴ – – = intermittent cardioplegia. (LVSWI = left ventricular stroke work index; mean AP = mean arterial pressure; PCWP = pulmonary capillary wedge pressure; SVR = systemic vascular resistance.) The Annals of Thoracic Surgery 2004 77, 664-671DOI: (10.1016/S0003-4975(03)01522-4)

Fig 4 Trends in mean PAP, RVSWI, PVR, and CVP. The duration of the procedure (Proc.) is represented by a hatched bar. These variables did not differ significantly among the groups by generalized estimating equation analysis. Student's t tests were significantly different at times 12 hours and 36 hours (p = 0.029 and 0.039, respectively) for CVP (asterisk). —■— = continuous cardioplegia; – – ▴ – – = intermittent cardioplegia. (CVP = central venous pressure; PAP = pulmonary arterial pressure; PVR = pulmonary vascular resistance; RVSWI = right ventricular stroke work index.) The Annals of Thoracic Surgery 2004 77, 664-671DOI: (10.1016/S0003-4975(03)01522-4)

Fig 5 Lactate (left) and hypoxanthine (right) concentrations were measured in the coronary sinus before aortic cross clamping and immediately after aortic clamp release. These markers of ischemia were markedly lower in the continuous cardioplegia group of patients. (■ = continuous cardioplegia; □ = intermittent cardioplegia.) The Annals of Thoracic Surgery 2004 77, 664-671DOI: (10.1016/S0003-4975(03)01522-4)

Fig 6 Plasma levels of the MB mass isoenzyme of creatine kinase (CK-MB) and of troponin I. The duration of the procedure (Proc.) is represented by a hatched bar. —■— = continuous cardioplegia; – – ▴ – – = intermittent cardioplegia. The Annals of Thoracic Surgery 2004 77, 664-671DOI: (10.1016/S0003-4975(03)01522-4)