Optimizing cardioplegia in cardiopulmonary bypass surgeries

Abstract

Aim. To investigate the influence of intentional cardiac arrest before cardioplegic solution infusion on cardioplegia quality and myocardial protection. Methods. We propose a method for optimizing cardioplegia, allowing to achieve asystole and pharmacologically prepare the myocardium to aortic clamping. The developed method uses systemic and intracoronary administration of adenosine triphosphate and lidocaine to cause asystole, which gives rapid and effective cardioplegic effect without threatening hypertension in coronary arteries. The described method was used in 724 patients who underwent surgery in the period from 2008 to 2013. Normothermic perfusion mode - without myocardial cooling with ice-slush - was used in all cases. Results. Cardiac activity restored spontaneously in 89.7% of cases, manifestations of reperfusion syndrome were negated, frequency and duration of inotropic support were significantly reduced, no serious arrhythmias, like AV block, ventricular tachyarrhythmias and extrasystoles were registered. The described method creates the conditions for sinus rhythm reversion in patients with atrial fibrillation, given the favorable anatomical and physiological conditions (heart chambers volume, duration and type of atrial fibrillation). Conclusion. The described method allows optimizing the surgical stage after standard pharmacological cardioplegia, provides more efficient cardioplegic solution delivery to the myocardium, which is especially important in patients with coronary artery disease, as well as parmacological preconditioning of myocardium before a long period of ischemia and thus to improve the clinical course of post-ischemic period