Volume 5 Supplement 7

3rd International Symposium on the Pathophysiology of Cardiopulmonary Bypass. Myocardial cell damage and myocardial protection

Open Access

Noncardioplegic myocardial protection in high-risk coronary artery bypass grafting

  • G Kleikamp1,
  • N Reiβ1,
  • N Mirow1,
  • B Hansky1,
  • A El-Banayosy1,
  • K Minami1 and
  • R Körfer1
Critical Care20015(Suppl 7):P10

DOI: 10.1186/cc1003

Received: 12 February 2001

Published: 6 March 2001

Introduction

This study was undertaken to determine whether intermittent aortic cross-clamping in the fibrillating heart can be used successfully in high-risk coronary artery bypass grafting.

Method

From 1 January 1988 to 30 April 2000, 25,887 patients underwent isolated coronary bypass grafting for coronary artery disease at our institution. In all cases, myocardial protection consisted of intermittent aortic cross-clamping in the fibrillating heart under mild hypothermia. A total of 908 patients (797 male [88%]; mean age 60.1 ± 9.5 years, range 29-78 years) were suffering from ischaemic cardiomyopathy defined as global (left ventricular ejection fraction <30%) and regional wall motion abnormalties. The pre-, peri- and postoperative data for this subgroup were entered prospectively into a database.

Results

Mean aortic cross-clamp time was 25.01 ± 8.2 min (range 0-46 min), mean perfusion time was 60.8 ± 26.3 min (range 19-336 min), and the number of bypass grafts per patient was 3.11 ± 0.927. Weaning from extracorporeal circulation was possible without catecholamines in 348 patients (38%); 560 (62%) received dopamine intravenously. Intra-aortic balloon counterpulsation was used in 85 patients (9%) and assist devices were used in nine patients. Twenty-eight patients (3.1%) suffered from perioperative myocardial infarction, 96 patients developed ventricular arrhythmia and 191 atrial fibrillation. Ventilatory support for longer than 24 h was required by 118 patients. Eighteen patients (2.0%) died within 30 days of the operation.

Conclusion

Intermittent aortic cross-clamping in the fibrillating heart can be used safely for myocardial protection in all patients undergoing surgical revascularization. The results even in this high-risk group of patients compare favourably with all published series utilizing other forms of myocardial protection. Furthermore, this method is easy to use and cost neutral.

Authors’ Affiliations

(1)
Department of Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University of Bochum

Copyright

© BioMed Central Ltd 2001

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