J.Jpn. Surg. Soc.. 91(9): 1438-1441, 1990
Report on the annual meeting
RETROGRADE CONTINUOUS COLD BLOOD CARDIOPLEGIA VIA THE CORONARY SINUS
－STUDY ON THE FACTORS AFFECTING MYOCARDIAL PROTECTION－
|
Division of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Japan Tetsuya Higami, Kyoichi Ogawa, Tatsuro Asada, Nobuhiko Mukohara, Masami Nishiwaki, Shinichiro Yamamoto*), Kazuo Nakamura*) |
In 27 patients with valvular heart disease, myocardial specimen was taken from the right ventricular wall just before aortic unclamping (AU) and the degree of injury to mitochondoria (MCI) was compared with the following 5 factors. They were 1) right ventricular myocardial temperature after initial cardioplegic infusion, 2) aortic cross-clamp time, 3) cold blood cardioplegia (CBCP) dose, 4) CBCP dose/left ventricular mass weight (LVMW) and 5) topical cooling. Although as whole MCI was trifle, the CBCP dose/LVMW had most significant correlation with MCI among others. The dose of more than 5ml/100g LVMW/min seemed preferable, whereas the dose exceeding 9ml/100g LVMW/min only invited lncrease ln serum potassium level.
In other 18 cases where the terminal warm blood cardioplegia (TWB) was used before AU, the MCI after AU was approximately equal to that before AU, but in 14 cases where TWB was not used, the MCI increased after AU.
Consequently the conclusions were as follows. 1) The most important factor for myocardial protection during RCCBCP was the CBCP dose/LVMW, and optimal dose was 5-9ml/100g LVMW/min. 2) Although clinically not significant, slight reperfusion injury was noticed on the mitochondorial level, and TWB was useful for preventing reperfusion injury.
To read the PDF file you will need Adobe Reader installed on your computer.