J.Jpn. Surg. Soc.. 80(6): 557-571, 1979
Original article
INTRAOPERATIVE MYOCARDIAL PROTECTION DURING AORTIC CROSS-CLAMPING.
(Ⅱ)Clinical Study
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1st Department of Surgery, School of Medicine, Kanazawa University (Director : Prof. T. Iwa) Atsushi Hashiba |
Clinicaly, the perfusate was injected from the bilateral coronary orifices in the cases with aortotomy and from the aortic root in the other cases. After the perfusate was injected, the heart was arrested within 10-20 sec. and cooled to about 20°C within a few minutes. A relaxed and flaccid heart and a bloodless operative field were maintained throughout the operation.
About 65% of the cases resumed spontaneous beating after unclamping of the aorta. The incidences of cardiac arrhythmias and ventricular fibrillation during the post-operative period were very much reduced.
Analysis of the post-operative serum enzymes (GPT, GOT, LDH, CPK) and the isozymes (MB-CPK, LDH (I) ) in the adult cases showed that this method was very effective in terms of myocardial protection. MB-CPK was one of the best indices for determing myocardial injuries and ventricular fibrillation over 60 min. was not desireable because of the significant elevation of the maximum value of the post-operative MB-CPK.
DPTI/TTI after the C-P bypass was a negative correlation with the maximum value of the postoperative MB-CPK.
After using this method, operative mortality was markedly reduced and it was possible to crossclamp the aorta for about 150 min.. Therefore, in the most serious cases of combined valvular diseases, it was possible to undertake the repairs of multiple valves (AVR+MVR+TAP) with safety.
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