The Clinical Analysis of the Intermittent Warm Blood Cardioplegia by Admixing Potassium Only

Song, Hyun; Lim, Han Jung; Je, Hung Kon; Yu, Yang Gi; Sorkine, Vitaliy; Matsuda, Naruto; Choo, Suk Jung; Lee, Jae Won; Song, Myung Gun

Abstract

BACKGROUND: Since the introduction of warm blood cardioplegic myocardial protection, the results of numerous clinical trials have been reported. However , the increased reliance oncrystalloid cardioplegia with longer cross clamp time, the controversies surrounding the issue of right ventricular protection with retrograde cardioplegia, and problems of securing a good operative field of vision have all been pointed out as unresolved. To overcome these shortcomings, Antonio et al, in 1995 published the use of intermittent warm blood cardioplegia by admixing potassium only with good clinical results. The obj ectives of the current investigation were to assess the effects and applicability of warm blood cardioplegia with potassium only. MATERIAL AND METHOD: From May of 1998 to January of 1999, the results of coronary surgery or open heart surgery in 70 patients under intermittent warm blood potassium only cardioplegia were compared with the results of 70 case matched patients undergoing similar operations with intermittent cold blood cardioplegia. RESULT: The amount of cardioplegic solution required during cardiopulmonary bypass(1463+/-68.0 min, 3584+/-179 min, p<0.001), the time to recovery of consciousness postoperatively(3.5+/-0.4 min, 4.9+/-0.8 min, p=0.044), intubation duration(10.8+/-0.8 hr , 13.2+/-0.6 hr , p=0.017), and the inci-dence of rrhythmia requiring the use of lidocaine(75.2+/-6.8 mg, 114.5+/-7.2 mg, p=0.006), which were found to be less in the warm potassium only group were statistically significant. However, the differences in postoperative cardiac enzymne elevation and postoperative mortality and morbidity were statistically insignificant.
CONCLUSION
The current study showed warm intermittent potassium only blood cardioplegia to be at least equally effective as cold intermittent blood cardioplegia in providing myocardial protection. Furthermore, the reduction in cardiopulmonary bypass, mental recovery and intubation times strongly support the use of this method for intraopertaive myocardial protection.