Abstract
The aim of this study is to compare the effects of colloidal cardioplegia and blood cardioplegia in patients who underwent cardiac surgical procedures with cardiopulmonary bypass, and to evaluate their influence on hemodilution, bleeding and consumption of donor blood products in a retrospective clinical study. 100 male patients who underwent cardiac surgical procedure were divided into two groups: 50 patients were administered intermittent normotherm or mild hypotherm (34 degrees C) Calafiore blood cardioplegia with potassium chloride 14,9%; 50 patients were administered one initial doses of cold Kirsch - solution followed from intermittent cold colloidal cardioplegia using hydroxyethyl starch (HES 450/0,7). Hemoglobin values after the first dose of cardioplegia were significantly lower in the HES-group than in the Calafiore- group). After the first dose of cardioplegia platelets count was lower in the HES-group than in the Calafiore-group. Hemoglobin and hematocrit values 24h postoperative were lower in the HES-group than in the Calafiore-group. There was no difference in chest-drainage bleeding 12h and 24h postoperative between the groups. The consumption of donor erythrocyte concentrate and fresh frozen plasma was significantly higher in the HES-than in the Calafiore- group. The choice of either colloidal or blood cardioplegia does not influence the postoperative chest-drainage bleeding. The results suggest that high molecular colloidal cardioplegia with HES-solution is associated with higher hemodilution during and after cardiopulmonary bypass and significantly increases the consumption of donor blood products.
Highlights
Myocardial state and need for the blood which circulating through coronary artery depend of the functional condition of the heart
Used and well established strategy is the pharmacologically induced, reversible, electromechanical, diastolic cardiac arrest achieved by direct infusion of cardioplegic crystalline solutions or blood cardioplegia in the coronary circulation
In our retrospective study we examined a crystalline - colloidal cardioplegia and a blood cardioplegia concerning their systemic influence on hemodilution during and after CPB, postoperative chest-drainage bleeding and the consumption of donor blood products
Summary
Myocardial state and need for the blood which circulating through coronary artery depend of the functional condition of the heart. As a sub-discipline of cardiac surgery, myocardial protection involves skillful application of techniques designed to protect the operated heart from injury. Used and well established strategy is the pharmacologically induced, reversible, electromechanical, diastolic cardiac arrest achieved by direct infusion of cardioplegic crystalline solutions or blood cardioplegia in the coronary circulation. The frequency of application, the amount of the solution and the style of application are under discussion. The advantages of every strategic application of cardioplegic technique should be compared against known disadvantages of that technique and a balance should be achieved, which enhances the safety of every cardiac operation as it is harmonized with the patient’s specific physiological needs ( ). The transfusion of donor blood or plasma decreases the patient’s safety because of potential risk of infection or allergic reactions and raises the costs of the procedure, which is increasingly important as the clinics are requested to focus on cost effectiveness
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