A clinical comparative study between crystalloid and blood-based St Thomas' hospital cardioplegic solution

• Published in: European journal of cardio-thoracic surgery 1999-01, Vol.15 (1), p.75-83
• Main Authors: Ibrahim, Mohamed F., Venn, Graham E., Young, Christopher P., Chambers, David J.
• Format: Article
• Language: English
• Subjects: Adenine Nucleotides - metabolism; Aged; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arrhythmias; Bicarbonates - therapeutic use; Biological and medical sciences; Calcium Chloride - therapeutic use; Cardioplegia; Cardioplegic Solutions - therapeutic use; Coronary Artery Bypass; Crystalloid Solutions; Electrocardiography; Female; Function; Heart Arrest, Induced - methods; Hemodynamics - drug effects; Humans; Intraoperative Period; Isotonic Solutions; Magnesium - therapeutic use; Male; Medical sciences; Metabolism; Middle Aged; Myocardial Ischemia - metabolism; Myocardial Ischemia - surgery; Myocardial protection; Myocardium - metabolism; Patients; Phosphocreatine - metabolism; Plasma Substitutes - therapeutic use; Postoperative Complications - prevention & control; Potassium Chloride - therapeutic use; Rehydration Solutions - therapeutic use; Sodium Chloride - therapeutic use; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(98)00287-5

Objective: Myocardial protection with blood cardioplegia during cardiac surgery is increasingly preferred, but few studies have compared the protective effects of crystalloid cardioplegia to the same solution with blood as the only variable. This clinical study compared the protective effects of crystalloid or blood-based St. Thomas' Hospital cardioplegic solution No. 1. Methods: Fifty higher risk patients undergoing elective coronary artery bypass surgery, with an ejection fraction less than 40%, were randomly allocated to receive cold (4°C) intermittent crystalloid St. Thomas' No. 1 cardioplegia (n=25), or a similar blood-based solution (n=25) with a haematocrit of 10–12%. We determined (1) peri-operative and post-operative arrhythmias, (2) left and right ventricular function (24 h) using the thermodilution technique, (3) left ventricular high-energy phosphate content sampled before ischaemia, the end of ischaemia and the end of bypass. Results: Pre-operative haemodynamic data, aortic cross-clamp and bypass times were similar in both groups of patients; there was no mortality. At the end of ischaemia there were no differences in ATP content between groups but creatine phosphate was maintained at a significantly (P