The effect of cold crystalloid versus warm blood cardioplegia on the myocardium during coronary artery bypass grafting

Elsayed A Fayad; Wesam F Aly Eddin; Mohamed A Amr

doi:10.35810/ects.v3i1.169

Elsayed A Fayad Department of Cardiothoracic Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt https://orcid.org/0000-0003-3542-5140
Wesam F Aly Eddin Department of Anesthesia, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Mohamed A Amr Department of Cardiothoracic Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

DOI: https://doi.org/10.35810/ects.v3i1.169

Keywords: Cardiac protection, Metabolism, Laboratory, Arrest, Ejection fraction, Motion abnormality

Abstract

Background: The optimal cardioplegic solution is still debated. The objective of this study was to compare the effect of cold crystalloid versus warm blood cardioplegia on the myocardial injury during coronary artery bypass grafting.

Methods: The study included 34 consecutive patients who underwent elective primary on-pump isolated coronary artery bypass grafting from 2016 to 2019. We randomly assigned the patients into two groups. Group (ICCC) (n= 17) received intermittent antegrade cold crystalloid cardioplegia and Group (IWBC) (n= 17) received intermittent antegrade warm blood cardioplegia.

Results: There was no difference in the preoperative and operative variables between groups. The time taken by the heart to regain normal sinus rhythm was significantly longer in the cold crystalloid group (7.06 ± 1.8 vs. 2.17 ± 0.8 minutes, p<0.001) with a higher rate of reperfusion ventricular arrhythmia (35% versus 6%; p=0.03) compared to the warm blood cardioplegia group. Both coronary sinus acid production and lactate level were significantly higher in the warm blood group than in the cold crystalloid group (p< 0.001 and 0.043, respectively). The ischemic ECG changes and the severity of new segmental wall motion abnormalities were non-significantly different between both groups (p= 0.68 and 0.67, respectively). Postoperative CK-MB and cTnI levels in all-time points were not significantly different between groups (p= 0.46 and 0.37, respectively). ICU (2.29 ± 0.77 vs. 2.41 ± 0.87 days, p= 0.68) and hospital stay (9.28 ± 0.76 vs. 9.42 ± 0.88 days, p= 0.62) were non-significantly different between both groups.

Conclusion: Intermittent antegrade cold crystalloid cardioplegia was associated with attenuated myocardial metabolism. However, it was associated with a longer time to regain normal sinus rhythm and more reperfusion ventricular arrhythmias. We did not find differences in the clinical and echocardiographic outcomes and cardiac enzymes between cold crystalloid and warm blood cardioplegia.