Assessment of protective effects of Warm Terminal Blood Cardioplegia on Myocardial Protection in CABG

Introduction: Coronary artery disease
A significant metabolic derangement
occurs in the ischaemic-reperfused
heart of patients undergoing coronary
artery bypass surgery using cold blood
cardioplegia . It has been reported that
up to one forth of deaths after coronary
artery bypass grafting surgery may be
caused by Reperfusion injury especially
in patients with higher NYHA classes.
There are evidences that in adult
cardiac operations, a warm cardioplegic
reperfusate (hot shot) before removing
the aortic cross-clamp improves
postbypass myocardial function and
metabolic recovery . We randomly
assigned 41 consecutive patients
undergoing primary, elective CABG into
two groups; TWBC Group who received
Terminal Warm Blood Cardioplegia just
before removing of Aortic cross clamp
(n=24) and second group (Control) did
not received TWBC (n=17). Among
patients in CONTROL group 41%
(95% CL: 19-62%) received at least one
inotrope, but only 17% (95% CL: 0 -
35%) of patients in TWBC group did so
(p = 0.085). Also in respect to EF there
was superiority in TWBC group only in
patients with low pre operative EF. There
was higher rate of spontaneous beating
in TWBC group (21 of 24 or 88%)
versus Control group (12 of 17 or 70%;
P<0.1). Conclusion: it seems prudent
to routinely use Terminal Warm Blood
Cardioplegia in patients undergoing
coronary bypass graft especially in those
with reduced ventricular function