Warm Blood Cardioplegia Research Articles

Synergistic effects of remote perconditioning with terminal blood cardioplegia in an in vivo piglet model.

This study tested the hypothesis that remote perconditioning offers effective and synergistic cardioprotection to terminal warm blood cardioplegia for prompt ventricular recovery after prolonged cardioplegic arrest in an in vivo piglet model. Twenty-four piglets were subjected to 120 min of single-dose cardioplegic arrest and were divided into 4 groups according to the mode of reperfusion: control (simple aortic unclamp), remote perconditioning, terminal warm blood cardioplegia or remote perconditioning + terminal warm blood cardioplegia; remote perconditioning (4 cycles of 5-min ischaemia-reperfusion of the lower limb) was applied prior to aortic unclamping. Left ventricular systolic and diastolic functions were assessed by pressure-volume loop analysis at baseline and after 60 min of reperfusion. Biochemical injury was evaluated by plasma troponin T level. The control group showed decreased end-systolic elastance, preload recruitable stroke work and inverse of end-diastolic pressure-volume relationship of 51.3 ± 14.0%, 46.1 ± 22.5% and 34.8 ± 14.9%, respectively. Percentage recovery of end-systolic elastance and preload recruitable stroke work were significantly better with terminal warm blood cardioplegia (with or without remote perconditioning) (end-systolic elastance: 95% confidence interval, 38.6-84.1; preload recruitable stroke work: 95% confidence interval, 0.4-54.3). Percentage recovery of inverse of end-diastolic pressure-volume relationship was significantly better in the remote perconditioning groups (with or without terminal warm blood cardioplegia) (95% confidence interval, 1.6-41.6). No synergistic effects of remote perconditioning and terminal warm blood cardioplegia on troponin T release were noted. Remote perconditioning offers promising synergistic cardioprotection to terminal warm blood cardioplegia, implicating potential clinical benefit by contributing to prompt left ventricular functional recovery during paediatric open-heart surgery.

Metabolomic profiling in patients undergoing Off-Pump or On-Pump coronary artery bypass surgery

BackgroundCoronary artery bypass surgery can be performed without (Off-Pump) or with cardiopulmonary bypass (On-Pump). Extracorporeal circulation and cardioplegic arrest may cause alterations in the plasma metabolome. We assessed metabolomic changes in patients undergoing On-Pump or Off-Pump coronary artery bypass surgery.MethodsWe assessed five analyte classes (41 acylcarnitines, 14 amino acids, 92 glycerophospholipids, 15 sphingolipids, sugars, lactate) using a mass-spectrometry-based kit (Biocrates AbsoluteIDQ® p150) in paired arterial and coronary sinus blood obtained from 10 consecutive On-Pump and 10 Off-Pump patients. Cardioplegia for On-Pump was warm blood Calafiore. On-Pump outcomes were corrected for hemodilution through crystalloid priming.ResultsDemographic data were equal in both groups with normal ejection fraction, renal and liver function. Patients received 2.25 ± 0.64 bypass grafts. All postoperative courses were uneventful. Of 164 measured metabolites, only 13 (7.9%) were altered by cardiopulmonary bypass. We found more long-chain acylcarnitines Off-Pump and more short-chain acylcarnitines On-Pump. Glycerophospholipids showed lower concentrations On-Pump and arginine (as the only different amino acid) Off-Pump. Interestingly, plasma arginine (nitric oxide precursor) concentration at the end of surgery correlated inversely with postoperative vasopressor need (r = −0.7; p < 0.001). Assessing arterial/venous differences revealed phosphatidylcholine-production and acylcarnitine-consumption. These findings were unaffected by cardiopulmonary bypass, cardioplegia or temporary vessel occlusion during Off-Pump surgery.ConclusionsCardiopulmonary bypass and warm blood cardioplegia cause only minor changes to the metabolomic profile of patients undergoing coronary artery bypass surgery. The observed changes affected mainly acylcarnitines. In addition, there appears to be a relationship between arginine and vasopressor need after bypass surgery.

Acute-phase proteins and oxidative stress in patients undergoing coronary artery bypass graft: comparison of cardioplegia strategy.

IntroductionSeveral strategies are still being introduced to cardiac surgery techniques to reduce the signs of the inflammatory response and oxidative stress. Many efforts have been made to develop the best possible method for myocardial protection.AimTo assess the effect of the cardioplegia strategy on the systemic inflammatory response and oxidative stress.Material and methodsA group of 238 consecutive, elective on-pump coronary artery bypass graft patients (CABG; 183 men, aged 64.6 ±8.1 years) were prospectively studied. Patients were enrolled in two groups: with warm blood cardioplegia (n = 124) and with cold crystalloid cardioplegia (n = 114). In each group, pre- and postoperative levels of plasma C-reactive protein, fibrinogen, interleukin 6 and 8-iso-prostaglandin F2α (8-iso-PGF2α) were measured.ResultsAll studied markers significantly increased 18–36 h following CABG and then decreased in 5–7 postoperative days but remained above baseline levels. No differences in terms of studied markers and clinical outcomes were noted for the different types of cardioplegia. Regression analysis showed a significant correlation between preoperative level of oxidative stress measured by 8-iso-PGF2α and postoperative myocardial infarction as well as in-hospital cardiovascular death (p = 0.047 and p = 0.041 respectively).ConclusionsThis study extends previous reports by showing that the type of cardioplegia does not affect the systemic inflammatory response or oxidative stress, which are associated with the CABG procedure. It might be speculated that preoperative screening of oxidative stress could be helpful in identifying patients at increased risk of an unfavorable course after CABG.

Myocardial protection during CABG: Warm blood versus cold crystalloid cardioplegia, is there any difference?

BackgroundUp till now there is lack of consensus to the optimal method for cardioplegia delivery in coronary artery bypass graft (CABG) patients. Various strategies have been developed to minimize ischemic-reperfusion injury.The aim of this study was to compare cold crystalloid cardioplegia and warm blood cardioplegia in patients undergoing CABG. MethodsPatients (n = 100) undergoing CABG were prospectively randomized into group 1 (n = 50) which received antegrade cold crystalloid cardioplegia, group 2 (n = 50) which received antegrade warm blood cardioplegia. Blood samples were collected immediately, 12, and 24 h postoperatively and CK, CKMB, and Cardiac Troponin I were measured and compared between the two groups which were the indicator of myocardial cell injury (the primary end point of this study). Other indicators such as spontaneous defibrillation, use of intra-aortic balloon counter pulsation (IABC), and use of inotropic support were also documented. ResultsPreoperative demographic and clinical variables were matched in both groups. However, intraoperatively, the use of inotropic support was significantly higher in Group I compared to Group II (P = 0.032). Postoperative CK, CKMB and Troponin I were significantly higher in group (I) compared to group (II). ConclusionA significant reduction in the release of cardiac enzymes in patients who received antegrade warm blood cardioplegia suggests better myocardial protection compared to cold crystalloid cardioplegia.

Rationale for Implementation of Warm Cardiac Surgery in Pediatrics.

Cardiac surgery was developed thanks to the introduction of hypothermia and cardiopulmonary bypass in the early 1950s. The deep hypothermia protective effect has been essential to circulatory arrest complex cases repair. During the early times of open-heart surgery, a major concern was to decrease mortality and to improve short-term outcomes. Both mortality and morbidity dramatically decreased over a few decades. As a consequence, the drawbacks of deep hypothermia, with or without circulatory arrest, became more and more apparent. The limitation of hypothermia was particularly evident for the brain and regional perfusion was introduced as a response to this problem. Despite a gain in popularity, the results of regional perfusion were not fully convincing. In the 1990s, warm surgery was introduced in adults and proved to be safe and reliable. This option eliminates the deleterious effect of ischemia–reperfusion injuries through a continuous, systemic coronary perfusion with warm oxygenated blood. Intermittent warm blood cardioplegia was introduced later, with impressive results. We were convinced by the easiness, safety, and efficiency of warm surgery and shifted to warm pediatric surgery in a two-step program. This article outlines the limitations of hypothermic protection and the basic reasons that led us to implement pediatric warm surgery. After tens of thousands of cases performed across several centers, this reproducible technique proved a valuable alternative to hypothermic surgery.

Experience of one hundred cases of ASD closure

jdjdBackground &amp; Objectives: Atrial Septal Defect is a common congenital heart disease and surgical closure is the treatment of choice in many cases. This article presents the diagnostic criteria, surgical technique and postoperative management of hundred consecutive patients operated by a single surgeon at single centre.Materials and methods: One hundred (100) patients having atrial septal defect (ASD) underwent surgery at Osmania General Hospital, OMC, Hyderabad between January 1990 and October 1998. Sixty eight percentages (68%) of the patients were females and 32% of the patients were male. Fifty nine percentages (59%) of patients were in the age group of 11-30 yrs. Majority of the patients (70%) were symptomatic and were in NYHA class II. 'O' Rh-positive blood group was found in 35% of patients. Associated cardiac lesions were present in 28% of cases. One case each of Cortriatrium, Lutembacher's syndrome and Holt-Oram syndrome were present in this series. Eighty nine percentages (89 %) were moderate sized defects repaired by direct closure where as rest of 11% needed patch repair. Cold crystalloid cardioplegia with moderate hypothermia (28°C) was employed in 83 cases, ventricular fibrillation at normothermia in 5 cases and normothermic warm blood cardioplegia with continuous perfusion of coronary arteries in 12 patients.Results: Total duration of cardiopulmonary bypass ranged from 21 minutes to 100 minutes (mean duration 54.4 minutes) and aortic cross clamp time ranged from 10 minutes to 68 minutes (mean duration 22.9 minutes). Blood transfusion requirement ranged from 1 unit to 10 units (mean 3.1 units). There was no hospital death. Postoperative complication rate was 15%.Conclusion: Atrial septal defect closure is a safe, simple and effective operation with excellent long term results.Journal of College of Medical Sciences-Nepal, Vol.11(4) 2015: 9-13

Surgical Treatment of Anomalous Aortic Origin of Coronary Arteries: The Reimplantation Technique and Its Modifications

Although anomalous aortic origin of a coronary artery has been described as a benign anomaly in the past, several reports suggest that such an anomaly may be the cause of sudden death in children and younger adults. Increased cardiac output during exercise may result in compression of the anomalous coronary artery when it runs between the aorta and the pulmonary artery or when its aortic origin is narrowed and its proximal course is intramural. It is unlikely that this rare anomaly would be identified during infancy, but once diagnosis has been made, indication to proceed with surgery is controversial. Nevertheless, if surgery is recommended, several operative techniques may be used, depending on the specific anatomy; unroofing, direct reimplantation, patch enlargement, and even coronary artery bypass grafting have been proposed. In this short report, we focus on different techniques of coronary reimplantation. As we already know from the arterial switch operation in neonates and from aortic root repair or replacement in adults, sufficient mobilization is necessary to allow direct reimplantation in the correct sinus to avoid kinking and other distortion.

Six-years survival and predictors of mortality after CABG using cold vs. warm blood cardioplegia in elective and emergent settings.

BackgroundThe aim of this study was to determine whether intermittent warm blood cardioplegia (IWC) is associated with comparable myocardial protection compared to cold blood cardioplegia (ICC) in patients undergoing elective vs. emergent CABG procedures.MethodsOut of 2292 consecutive patients who underwent isolated on-pump CABG surgery using cardioplegic arrest either with ICC or IWC between January 2008 and December 2010, 247 consecutive emergent patients were identified and consecutively matched 1:2 with elective patients based on gender, age (<50 years, 50–70 years, >70 years) and ejection fraction (<40 %, 40–50 %, >50 %). Perioperative outcomes and long-term mortality were compared between ICC and IWC strategies and predictors for 30-day mortality and perioperative myocardial injury were identified in both elective and emergent subgroups of patients.ResultsPreoperative demographics and baseline characteristics, logistic Euroscore, CPB-time, number of distal anastomoses and LIMA-use were comparable. Aortic cross clamp time was significantly longer in the IWC-group regardless of the urgency of the procedure (p = 0.05 and p = 0.015 for emergent and elective settings). There were no significant differences regarding ICU-stay, ventilation time, total blood loss and need for dialysis. The overall 30-day, 1-, 3- and 6-year survival of the entire patient cohort was 93.7, 91.8, 90.4 and 89.1 %, respectively, with significantly better outcomes when operated electively (p < 0.001) but no differences between ICC and IWC both in elective (p = 0.857) and emergent (p = 0.741) subgroups. Multivariate analysis did not identify the type of cardioplegia as a predictor for 30-day mortality and for perioperative myocardial injury. However, independent factors predictive of 30-day mortality were: EF < 40 % (OR 3.66; 95 % CI: 1.79–7.52; p < 0.001), atrial fibrillation (OR 3.33; 95 % CI: 1.49-7.47; p < 0.003), peripheral artery disease (OR 2.51; 95 % CI: 1.13–5.55; p < 0.023) and COPD (OR 0.26; 95 % CI: 1.05–6.21; p < 0.038); predictors for perioperative myocardial infarction were EF < 40 % (OR 2.04; 95 % CI: 1.32–3.15; p < 0.001), preoperative IABP support (OR 3.68; 95 % CI: 1.34-10.13; p < 0.012), and hemofiltration (OR 3.61; 95 % CI: 2.22–5.87; p < 0.001).ConclusionAlthough the aortic cross clamp time was prolonged in the IWC group our results confirm effective myocardial protection under IWC, regardless of the urgency of the procedure. We suggest that intermittent warm cardioplegia in emergent CABG setting is a low-cost alternative and safe. It is associated with similar long-term outcomes both in elective and emergent settings compared to intermittent cold cardioplegia.

Comparison of Warm Blood Cardioplegia Delivery With or Without the Use of a Roller Pump

Various techniques for administration of blood cardioplegia are used worldwide. In this study, the effect of warm blood cardioplegia administration with or without the use of a roller pump on perioperative myocardial injury was studied in patients undergoing coronary artery bypass grafting using minimal extra-corporeal circuits (MECCs). Sixty-eight patients undergoing elective coronary bypass surgery with an MECC system were consecutively enrolled and randomized into a pumpless group (PL group: blood cardioplegia administration without roller pump) or roller pump group (RP group: blood cardioplegia administration with roller pump). No statistically significant differences were found between the PL group and RP group regarding release of cardiac biomarkers. Maximum postoperative biomarker values reached at T1 (after arrival intensive care unit) for heart-type fatty acid binding protein (2.7 [1.5; 6.0] ng/mL PL group vs. 3.2 [1.6; 6.3] ng/mL RP group, p = .63) and at T3 (first postoperative day) for troponin T high-sensitive (22.0 [14.5; 29.3] ng/L PL group vs. 21.1 [15.3; 31.6] ng/L RP group, p = .91), N-terminal pro-brain natriuretic peptide (2.1 [1.7; 2.9] ng/mL PL group vs. 2.6 [1.6; 3.6] ng/mL RP group, p = .48), and C-reactive protein (138 [106; 175] μg/mL PL group vs. 129 [105; 161] μg/mL RP group, p = .65). Besides this, blood cardioplegia flow, blood cardioplegia line pressure, and aortic root pressure during blood cardioplegia administration were similar between the two groups. Administration of warm blood cardioplegia with or without the use of a roller pump results in similar clinically acceptable myocardial protection.

Improved Contractility with Modified Tepid Full Blood Cardioplegia Compared to Cold Crystalloid Cardioplegia in a Piglet Model

Objectives: Experience regarding warm blood cardioplegia according to Calafiore results from its broad use in adult patients. In this experimental study, tepid (28°C) modified full blood cardioplegia (MBC) was adopted for pediatric use and compared with cold crystalloid cardioplegia (CCC).

Endothelial Injury Associated with Cold or Warm Blood Cardioplegia during Coronary Artery Bypass Graft Surgery.

The aim of this investigation was to analyze the impact of intermittent cold blood cardioplegia (ICC) and intermittent warm blood cardioplegia (IWC) on endothelial injury in patients referred to elective on-pump coronary artery bypass graft (CABG) surgery. Patients undergoing CABG procedures were randomized to either ICC or IWC. Myocardial injury was assessed by CK-MB and cardiac troponin T (cTnT). Endothelial injury was quantified by circulating endothelial cells (CECs), von Willebrand factor (vWF), and soluble thrombomodulin (sTM). Perioperative myocardial injury (PMI) and major adverse cardiac events (MACE) were recorded. Demographic data and preoperative risk profile of included patients (ICC: n = 32, IWC: n = 36) were comparable. No deaths, PMI, or MACE were observed. Levels of CK-MB and cTnT did not show intergroup differences. Concentrations of CECs peaked at 6 h postoperatively with significantly higher values for IWC-patients at 1 h (ICC: 10.1 ± 3.9/mL; IWC: 18.4 ± 4.1/mL; P = 0.012) and 6 h (ICC: 19.3 ± 6.2/mL; IWC: 29.2 ± 6.7/mL; P < 0.001). Concentrations of vWF (ICC: 178.4 ± 73.2 U/dL; IWC: 258.2 ± 89.7 U/dL; P < 0.001) and sTM (ICC: 3.2 ± 2.1 ng/mL; IWC: 5.2 ± 2.4 ng/mL; P = 0.011) were significantly elevated in IWC-group at 1 h postoperatively. This study shows that the use of IWC is associated with a higher extent of endothelial injury compared to ICC without differences in clinical endpoints.

Coronary Sinus Lactate as Marker of Myocardial Ischemia in Cardiac Surgery: Correlation with Morbidity and Mortality after Cardiac Surgery / Lactatul din sinusul coronarian - marker al ischemiei miocardice în chirurgia cardiacă: corelaţii cu morbiditatea şi mortalitatea postoperatorie

AbstractIntroduction. Perioperative myocardial injuries are one of the most frequent causes of morbidity and mortality after cardiac surgery, the most common etiology being the poor myocardial protection during aortic crossclamp. During aortic crossclamp progressive accumulation of lactate and intracellular acidosis are well-known phenomena, and are associated with alteration of myocardial contractile function. Our objective was to study the coronary sinus lactate levels as a predictor of postoperative hemodynamic outcome in open-heart surgical patients.Material and methods. We performed a prospective clinical trial, including 142 adult patients with elective cardiac surgery. Anterograde cardioplegia was administered in 82 patients, retrograde cardioplegia in 60 (in 30 patients it was administrated intermittently and in 30 continuously). Blood was collected simultaneously from the aortic cardioplegic line (inflow) and from coronary sinus or the aortic root (outflow) before aortic crossclamp, after crossclamp at every 10 minutes and after crossclamp removal at 0 and 10 minutes. All patients were operated on cardiopulmonary bypass with cardiac arrest, using warm-blood cardioplegia for cardioprotection.Results. Lactate levels showed increasing values during aortic crossclamp, and a rapid decline after crossclamp removal. The incidence of low cardiac output was significantly higher in patients with lactate levels that exceeded 4 mmol/L. In patients who died in the postoperative period, lactate level was even higher (5 mmol/L), with only a modest recovery after crossclamp removal.Conclusion. Monitoring lactate level in coronary sinus blood is a reliable method and has a good prognostic value regarding postoperative morbidity and mortality in open heart surgery

Myocardial ischemia/reperfusion reaction after warm vs. cold Calafiore blood cardioplegia

Background: Because of conflicting reports regarding the superiority of cold or warm blood cardioplegia, we compared the postischemic myocardial function of rat hearts after application of blood cardioplegia (BCP) in two different temperatures.

The impact of using warm vs. cold blood cardioplegia in patients underwent emergent CABG procedure

Objective: Aim of this study was to determine whether intermittent warm (IWC) or cold bloodcardioplegia (ICC) show superior myocardial protection in emergent CABG-patients with less than 60 minutes aortic cross-clamp time (Ao-X).

Use of cold blood cardioplegia equalizes higher risk profile in CABG patients with acute coronary syndrome compared to warm blood cardioplegia

Use of cold blood cardioplegia equalizes higher risk profile in CABG patients with acute coronary syndrome compared to warm blood cardioplegia

Myocardial Protection during Cardiac Surgery: Warm Blood versus Crystalloid Cardioplegia

Purpose: Prevention of myocardial injury is essential during cardiac surgery. Both crystalloid and blood cardioplegia are popular methods for myocardial protection. Most experimental studies have been in favor of blood cardioplegia. The objective of this study is to determine whether the use of warm blood cardioplegia (BCP) is superior to crystalloid cardioplegia (CCP) by means of myocardial injury markers and clinical outcome parameters. Materials and Methods: In a consecutive series of 293 patients, the first 150 received crystalloid cardioplegia, whereas the next 143 patients received blood cardioplegia. Postoperative myocardial injury was assessed by CTnI and CK-MB. Perioperative morbidity and mortality and clinical outcome parameters (need for inotropic support, ICU and hospital stay) were recorded. An unpaired student t-test was performed to analyse continuous postoperative variables relating to myocardial damage. The presence of possible confounders influencing the CTnI or CK-MB concentrations was tested using a student t-test for continuous variables, for categorical variables ANOVA was used. A final longitudinal model was created for CTnI and CK-MB. CTnI was analyzed by a mixed model with random intercept and slope. For all tests performed, statistical significance was 5%. Results: Both groups were well matched with respect to preoperative variables. No significant difference could be found in maximum postoperative levels of CTnI (8.8 ± 18.4 μg/l in BCP vs 9.6 ± 16.5 μg/l in CCP, p = 0.6455) or CK-MB (19.2 ± 31.0 μg/l in BCP vs 26.4 ± 41.5 μg/l in CCP, p = 0.1209). Nor was there any significant difference in other postoperative variables. Testing treatment effect over time proved only significant influence of the surgical intervention type on CTnI levels in time (p

Intermittent cold-blood vs. warm-blood cardioplegia – a comparative study on myocardial acidosis during coronary bypass surgery

The aim of the study was to assess the impact of the intermittent cold-blood cardioplegia (ICBC) on myocardial acidosis in comparison to the warm-blood cardioplegic administration (IWBC) in patients undergoing coronary bypass surgery. In 15 patients undergoing elective bypass surgery with ICBC for myocardial protection, metabolic changes of global ischemia indicators with lactate and pH values, measured simultaneously in the arterial and coronary sinus blood, were analyzed and compared with those observed when warm-blood method was used. For comparison, the analysis of variance with repeated measurements including tests for a cross-over effect of group and time was used. In patients with ICBC compared to IWBC, the lactate production as well as degree of acidosis were generally lower with a significant group effect for both, lactate and pH values measured at the end of reperfusions. Our results suggest that ICBC has an inhibiting effect on potentially progressive myocardial acidosis during cross clamp period.

Randomized trial of HTK versus warm blood cardioplegia for right ventricular protection in mitral surgery

Objectives. To clarify the reliability of the one-shot histidine–tryptophane–ketoglutarate (HTK) cardioplegia for right ventricular (RV) myocardial protection during mitral surgery, in patients with or without pre-operative RV dysfunction. Design. Sixty patients undergoing isolated mitral surgery were randomized to myocardial protection with either one-shot HTK or intermittent warm blood cardioplegia (WBC). The RV function was assessed by echocardiography and hemodynamic assessment. Pre-operative tricuspid annular plane systolic excursion (TAPSE), an index of RV systolic function was used to dichotomize groups into patients having impaired (TAPSE < 15) or preserved (TAPSE ≥ 15) RV function. Results. There were no significant intergroup differences in the post-operative indexes of RV function in cases with TAPSE ≥ 15. In patients having TAPSE < 15 we observed statistically worse RV ejection fraction (RVEF, 15% ± 2% vs. 24% ± 3%), end-diastolic volume (RVEDV, 188 mL ± 20 vs. 179 mL ± 14) and fractional area change (RVFAC, 21% ± 6% vs. 30% ± 3%) after use of the HTK solution versus patients who received the WBC. These differences were associated with longer mechanical ventilation and ICU times in patients with impaired RV function and receiving HTK cardioplegia. In a substudy ten patients with TAPSE < 15 received intra-operative topical myocardial cooling in addition to HTK. The addition of topical cooling to HTK cardioplegia yielded statistically significant amelioration in post-operative RV function compared with patients who received the HTK solution without topical cooling (RVEF: 23% ± 3% vs. 15% ± 2%; RVEDV: 180 mL ± 9 vs. 188 mL ± 18; RVFAC: 8.5% ± 1% vs. 6% ± 2%). Conclusions. The one shot HTK solution offers inferior RV protection compared with WBC, mainly in patients with depressed pre-operative RV function. When adopting HTK cardioplegia the addition of topical cooling is strongly advised.

ASSA13-08-2 Risk Factors For Simultaneous Carotid Endarterectomy and Coronary Artery Bypass Grafting

<h3>Objectives </h3> The determination of the risk factors of neurological complications for simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) and the ways to reduce them. <h3>Methods</h3> 7568 patients (mean age 61.3 ± 7.3, men prevailed) underwent CABG during the period 2003 – 2010. Simultaneous surgical procedures (SSP) - CEA + CABG were performed in 229 (3.0%) cases. In all patients CEA was performed as the first stage, CABG as the next one. The present research consists of 2 parts: retrospective analysis of 123 SSP and prospective evaluation of 106 SSP. <h3>Results</h3> 229 SSP (CEA + CABG) were performed using cardiopulmonary bypass (CB) and warm blood cardioplegia. Mean duration of surgery was 287 ± 41min, CB – 96 ± 27 min, anoxia – 61 ± 27 min, carotid cross-clamping – 13.3 ± 3.5 min. Performing SSP at first we registered a considerable rate of neurological complications in patients with bilateral carotid disease: ischemic stroke – 11.2%, mortality rate – 5.8%. The retrospective multivariate logit regression analysis of the results of 123 SSP detected the following risk factors for ischemic stroke: contralateral stenosis of internal carotid artery (ICA) &gt; 75% (p = 0.049), system hypothermia (rectal temperature) &gt; 29 °C (p = 0.031). Consequently, since 2010 we changed the surgical approach in patients with combined coronary and carotid disease. Thus, patients with contralateral stenosis of ICA &gt; 75% undergo surgery in system hypothermia with &lt; 29 °C. In the prospective part of the analysis of 106 SSP 2 groups were reviewed: group 1 – 57 (53.7%) patients with bilateral stenosis of ICA &gt; 75%; group 2 – 49 (46.3%) patients with unilateral stenosis of ICA &gt; 75%.In group 1 stroke was registered in 1.75%, mortality rate was 1.75%. In group 2 stroke was observed in 2%, mortality rate was 2%. <h3>Conclusions</h3> The risk factors for ischemic stroke for SSP (CEA + CABG) are contralateral stenosis of ICA &gt; 75%, system hypothermia (rectal temperature) &gt; 29 °C. The use of hypothermic perfusion on the CEA phase of SSP in patients with bilateral stenosis of ICA &gt; 75% effectively reduces neurological complications (9 times less), stroke rate (6.5 times less (p = 0.047)), mortality rate (3 times less (p = 0.3)).

Myocardial Protection Era: From Valve Surgery to Heart Transplantation

Myocardial Protection Era: From Valve Surgery to Heart Transplantation