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The Annals of Thoracic Surgery, Vol 58, 1690-1694, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

Is there a place for cold crystalloid cardioplegia in the 1990s?

PJ Hendry, RG Masters and A Haspect
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario, Canada.

New cardioplegic techniques have been advocated as advantageous when compared with previously accepted standard methods. This study assessed results of a recent cohort of 388 consecutive patients undergoing coronary artery bypass grafting between 1990 and 1992 using a standard cold crystalloid cardioplegia. The mean age of patients was 61.0 +/- 0.5 years; there were 324 male and 64 female patients. Risk factor distribution has not changed recently. Preoperative left ventricular dysfunction (grade III/IV) was significant in 35.1% of patients, and 63.3% had previous myocardial infarctions. Intraoperative cardiac arrest was achieved using an average of 1,254 +/- 14 mL of St. Thomas' solution in multiple doses. Patients had a mean of 3.1 +/- 0.04 grafts constructed, with 87.7% receiving at least one internal thoracic artery graft. Anoxia and total cardiopulmonary bypass times were 40.6 +/- 0.6 and 90.3 +/- 1.4 minutes, respectively. Perioperative myocardial infarction was identified in 5.7% of patients with elevated creatine kinase levels and electrocardiographic measurement changes, inotropic agents were required in 17.8%, and the intraaortic balloon was required in 3.6% of patients. Hospital stays averaged 11.2 +/- 0.5 days. Overall 30-day mortality was 1.0%, whereas those patients undergoing elective operation (n = 219) had a mortality of 0%. In conclusion, cold crystalloid cardioplegia has the advantages of being inexpensive and simple to use. These results suggest that coronary artery bypass grafting still may be performed very safely using this technique.

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