Warm Versus Cold Cardioplegia for Myocardial Protection in Coronary Artery Bypass Surgery: A prospective Comparative Study. | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 44, Issue 2, April 2025, Page 760-769 PDF (805.63 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2024.335660.1273 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Ramy M. R. Khorshid; Mohsen M. A. Fadala; Hossam E. A. A. Hamid; Samir A. K. H. Atta 
| ||||
| Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||||
| Abstract | ||||
| Background: Although both warm blood and cold crystalloid cardioplegia are frequently used to induce electromechanical arrest, it is unclear whether is more useful in clinical settings. These two cardioprotectives were compered in patients having coronary artery bypass grafting (CABG) in a prospective comparative research. Patients and Methods: A total of 50 people (30–70 years old) receiving isolated CABG at two tertiary centres in Egypt were the patients of our study. Depending on the surgeon’s option, patients were either given intermittent antegrade cold (4°C) crystalloid cardioplegia (n=25) or intermittent antegrade warm (34–35°C) blood cardioplegia (n=25). Myocardial enzyme release (creatine kinase [CK], CK-MB, and troponin I) measured 48h after surgery was the main outcome. Intraoperative, postoperative, and 3-month outcomes were examples of secondary endpoints. Results: There were no significant differences between groups in cardiopulmonary bypass or cross-clamp times (P>0.05 for both). Postoperatively, CK-MB levels were lower at 48h with cold crystalloid cardioplegia (mean 21.7 vs. 29.1ng/ml for warm blood, P=0.041). However, CK and troponin I profiles were similar between groups (P>0.05). No differences were demonstrated in duration of ventilation, ICU length of stay, or requirements for inotropes or IABP support (P>0.05 for all). The cold crystalloid group showed higher rates of postoperative cardiac events (37.5 vs. 12.5%, P=0.046) and abnormal echocardiographic wall motion at 3 months (34.8 vs. 8.7%, P=0.032). After adjustment for baseline renal function and glycemic control, the cardioplegia strategy was not an independent predictor of death or major adverse cardiac events. Conclusion: Clinical results showed that neither cold crystalloid cardioplegia nor warm blood cardioplegia was better for protecting the heart in patients having CABG. These results underline the necessity of more extensive, conclusive studies assessing myocardial management techniques in heart surgery. | ||||
| Keywords | ||||
| Cardioplegia; Creatine kinase MB; Coronary artery bypass; Myocardial protection | ||||
|
Statistics Article View: 11 PDF Download: 7 |
||||
