Warm blood cardioplegia versus cold crystalloid cardioplegia for coronary artery bypass grafting (CABG) in patients with low ejection fraction

Abstract

BackgroundPatients with reduced ejection fraction (EF) undergoing CABG are more likely to develop postoperative morbidity and mortality. It is controversial about which cardioplegia solution, temperature, and method of administration ensure optimal cardiac muscle preservation during CABG surgery.Aim of the studyThe aim of the study was to compare intermittent antegrade warm blood cardioplegia with cold crystalloid cardioplegia during CABG in patients with low EF (30–40%).MethodsPatients (n = 100) undergoing elective isolated on-pump CABG were prospectively randomized into group I (n = 50) which received antegrade cold crystalloid cardioplegia and group II (n = 50) which received antegrade warm blood cardioplegia. Blood samples were collected immediately and 12 and 24 h postoperatively. CK-MB and cardiac troponin I were measured and compared between the two groups. Other indicators such as use of inotropic support and use of intra-aortic balloon counter pulsation (IABC) were also documented.ResultsPreoperative demographic and clinical variables were matched in both groups. However, postoperative CK-MB and troponin I were higher in group I compared to group II. There was less need for inotropic support and IABC with better postoperative course in group II than in group I.ConclusionThere was a significant reduction in the release of cardiac enzymes and less need for inotropic support with better postoperative outcome in patients who received antegrade warm blood cardioplegia versus cold crystalloid cardioplegia.