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The Annals of Thoracic Surgery, Vol 58, 768-772, Copyright © 1994 by The Society of Thoracic Surgeons
JR Anderson, M Hossein-Nia, P Kallis, M Pye, DW Holt, AJ Murday and T Treasure
Despite the current trend for using blood cardioplegia, ventricular
fibrillation with intermittent ischemia is still used as a strategy to
manage the myocardium with impressive results. These two methods of
myocardial management were compared in 40 patients undergoing elective
coronary artery operations using creatine kinase MB isoforms and troponin T
assays. Each patient was randomized to have either cold blood cardioplegia
(n = 20) or ventricular fibrillation with intermittent ischemia (n = 20)
for myocardial management during the construction of distal anastomoses.
Until recently, the comparison of different methods of myocardial
management has been hindered by the lack of a specific and sensitive marker
of myocardial damage. Analysis of creatine kinase MB isoforms (MB2, cardiac
tissue form; MB1, plasma- modified form) and cardiac-specific troponin T (a
structural protein) has been shown to improve the sensitivity for the
detection of myocardial damage. There were no significant differences
between the two groups in age, sex ratio, extent of disease, or left
ventricular function. Blood samples for analysis were collected before
cross-clamp application and at time intervals up to 48 hours after. Median
peak creatine kinase MB2 activity was found to be significantly higher in
the blood cardioplegia group compared with ventricular fibrillation (26.5
U/L versus 19.5 U/L, respectively, p = 0.04). Although median peak troponin
T concentration was higher in the blood cardioplegia group, the difference
failed to reach significance (2.2 ng/mL versus 1.6 ng/mL, p =
0.15).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Comparison of two strategies for myocardial management during coronary artery operations
Department of Cardiothoracic Surgery, St. George's Hospital Medical School, London, United Kingdom.
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