Gasior Z, Krejca M, Szmagala P, Bochenek A
1st Cardiac Surgery Department, Silesian School of Medicine, Katowice, Poland.
J Cardiovasc Surg (Torino). 2000 Oct;41(5):695-702.
In an effort to define the role of blood cardioplegia delivered in antegrade/retrogade fashion in patients with either good or poor left ventricular function undergoing elective coronary artery bypass surgery, we initiated a prospective randomised study in which postoperative hemodynamics besides clinical data were compared in patients administered antegrade/retrograde crystalloid cardioplegia.
To compare the efficiency of two methods of myocardial protection--cold crystalloid ante/retro cardioplegia and cold blood ante/retro cardioplegia in two groups of patients with high and low LVEF--we randomised 122 patients for CABG. The potential improvement in left ventricular systolic function assessed by echocardiography and the same clinical data were the end points of the study. Patients were divided into group I (47 patients, LVEF <40%) and group II (75 patients, LVEF >40%). Pathologic antecedents and preoperative clinical conditions were similar in both randomised subgroups Ia, IIa (crystalloid cardioplegia) and subgroups Ib, IIb (blood cardioplegia). The following parameters were measured: left atrium diameter (LA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), left ventricular wall motion score index (WMSI), and area asynergy (AA). All patients underwent echocardiography: A--prior the CABG, B--2-6 weeks postoperatively, C--3 months postoperatively, D--6 months postoperatively, E--1 year postoperatively.
The results of clinical assessment in both groups showed improvement of quality of life. The constant improvement of LVEF and WMSI was observed in group I in contrast to group II. There were no significant differences in postoperative left ventricular systolic function between subgroups Ia and Ib or IIa and IIb.
The use of blood cardioplegia, instead of crystalloid cardioplegia, when used in the ante/retrograde fashion during CABG has no influence on postoperative left ventricular systolic function. The improvement in left ventricular systolic function following CABG is greater in patients with low LVEF in contrast to patients with high LVEF.
为了明确在接受择期冠状动脉旁路移植术的左心室功能良好或较差的患者中，顺行/逆行方式输注血液停搏液的作用，我们开展了一项前瞻性随机研究，比较接受顺行/逆行晶体停搏液的患者的术后血流动力学及临床数据。
为比较两组左心室射血分数（LVEF）高低不同的患者中两种心肌保护方法——冷晶体顺行/逆行停搏液和冷血顺行/逆行停搏液的效果，我们将122例接受冠状动脉旁路移植术（CABG）的患者随机分组。通过超声心动图评估左心室收缩功能的潜在改善情况以及相同的临床数据作为研究终点。患者分为I组（47例，LVEF<40%）和II组（75例，LVEF>40%）。随机分组的亚组Ia、IIa（晶体停搏液）和亚组Ib、IIb（血液停搏液）的病理既往史和术前临床情况相似。测量以下参数：左心房直径（LA）、左心室舒张末期直径（LVEDD）、左心室收缩末期直径（LVESD）、左心室射血分数（LVEF）、左心室壁运动评分指数（WMSI）和面积协同性（AA）。所有患者均接受超声心动图检查：A——冠状动脉旁路移植术前，B——术后2 - 6周，C——术后3个月，D——术后6个月，E——术后1年。
两组的临床评估结果均显示生活质量有所改善。与II组相比，I组观察到LVEF和WMSI持续改善。亚组Ia与Ib或IIa与IIb之间术后左心室收缩功能无显著差异。
在冠状动脉旁路移植术期间以顺行/逆行方式使用血液停搏液而非晶体停搏液，对术后左心室收缩功能无影响。与左心室射血分数高的患者相比，冠状动脉旁路移植术后左心室射血分数低的患者左心室收缩功能改善更大。
