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Is repeated administration of blood-cardioplegia really necessary?

Department of Cardiac Surgery, Dresden Heart Center, Dresden Technical University, Germany

*Corresponding author. Herzzentrum Dresden GmbH, Universitätsklinik, Fetscherstrasse 76, 01307 Dresden, Germany. Tel.: +49-351-4501511; fax: +49-351-4501511.

E-mail address: tamer_ghazy{at}hotmail.com (T. Ghazy).

The aim of this work was to question the necessity of repeated administration of warm blood cardioplegia in modern cardiac surgery. A consecutive series of 4014 patients underwent cardiosurgical procedures in the period from January 2001 to December 2006 in our centre, where modified Calafiore warm blood-cardioplegic solution was used. 1708 patients received a single shot of cardioplegia instead of repeated blood cardioplegia (every 20 min). A multivariate analysis was performed using logistic regression models to reveal the statistical significance of the effect of single-shot cardioplegia on the occurrence of: death, intraoperative need of inotropics, intraoperative intra-aortic balloon pump (IABP), postoperative infarction, arrhythmia, postoperative need for inotropics and postoperative IABP. The results showed statistical insignificance concerning mortality (P=0.704), intraoperative IABP (P=0.247), postoperative inotropics (P=0.273), postoperative IABP (P=0.678), postoperative arrhythmia (P=0.661). Single-shot cardioplegia showed a positive effect concerning postoperative myocardial infarction (P=0.003). However, it showed an unfavourable effect concerning intraoperative inotropics (P=0.038) and postoperative dialysis (P=0.015). The clinical safety of the first shot of warm blood cardioplegia might be exceeding 20 min. In the light of increasingly short cross-clamping time, the safety of the first shot might be long enough to cover the whole cross-clamping time.

Key Words: Blood cardioplegia; Myocardial protection; Cardiopulmonary bypass

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				E. Apostolakis, I. Koniari, and D. Dougenis eComment: Individualization of blood cardioplegia administration mode Interactive CardioVascular and Thoracic Surgery, May 1, 2009; 8(5): 521 - 522. [Full Text] [PDF]

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				T. G. Ghazy, A. Ouda, and O. Allham eResponse: Re: Is repeated administration of blood-cardioplegia really necessary? Interactive CardioVascular and Thoracic Surgery, May 1, 2009; 8(5): 523 - 523. [Full Text] [PDF]

				L. A. Bockeria eComment: Re: Is repeated administration of blood-cardioplegia really necessary? Interactive CardioVascular and Thoracic Surgery, May 1, 2009; 8(5): 522 - 522. [Full Text] [PDF]