| The Optimum Temperature of the
Retrograde Continuous Blood Cardioplegia in Coronary Artery Bypass
Grafting |
| Noritsugu Morishige |
Tadashi Tashiro |
Takashi Yamada |
| Michio Kimura |
|
|
(Department of Cardiovascular Surgery, Fukuoka
University School of Medicine, Fukuoka, Japan)
|
Myocardial oxidative stress during
retrograde continuous blood cardioplegia (RCBC) was evaluated
in 35 patients undergoing elective aortocoronary bypass surgery.
The patients were divided into three groups: Group C (n=12)
received cold (20°C) RCBC, Group T (n=11) received tepid
(30°C) RCBC, and Group W (n=12) received warm (36°C) RCBC.
Myocardial oxidative stress was assessed by measuring the release
of oxidized glutathione (GSSG), malondialdehyde (MDA), and myeloperoxidase
(MPO) in the coronary sinus plasma before aortic clamping, at
1, 5, and 10min after unclamping. Myocardial oxygen uptake and
lactate release were assessed at the same times. Both the hemodynamic
recovery and the creatine kinase MB (CKMB) activity were measured
perioperatively until 24h after unclamping. In Group C, a significant
coronary sinus release of GSSG was found in the early reperfusion
period in comparison to Groups T and W. However, the peak CK-MB
activity was significantly lower in Group T than in Group W.
No significant difference in the release of MDA or MPO was noted
in the three groups. The recovery of oxygen uptake after unclamping
was rapid in Group T. The recovery in the left and right ventricular
functions and the myocardial lactate release were similar in
the three groups. In conclusion, tepid RCBC is considered to
protect the myocardium from ischemia-reperfusion injury better
than cold or warm blood cardioplegia under retrograde continuous
perfusion.
Jpn. J. Cardiovasc. Surg. 31：252-257(2002) |
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