Abstrakt
Aims. To compare the perioperative data of unselected adult patients undergoing elective cardiac surgery requiring the use of cardiopulmonary bypass and heart arrest.
Methods. Prospective, observational study involving 250 patients.
Four methods of antegrade cardioplegia / the following types of cardioplegic solutions based on preferences and decisions of cardiac surgeons were used: cold crystalloid St. Thomas' (group 1, n=115), Bretschneider HTK (group 2, n=60), warm blood St.
Thomas' (group 3, n=34) and cold blood St. Thomas' (group 4, n=41).
Results. The use of crystalloid cardioplegia (groups 1, 2) caused a significant decrease in haemoglobin and haematocrit levels just after the delivery of cardioplegic solution (P < 0.001), but at the end of cardiopulmonary bypass this drop persisted in group 2 - Bretschneider HTK only.
The considerable difference in kalemia between crystalloid cardioplegia (groups 1 and 2) and blood cardioplegia (groups 3 and 4) after the delivery of cardioplegic solution was detected (P < 0.001), but there were no significant differences in kalemia levels at the end of cardiopulmonary bypass (P = 0.169). The shortest onset of isoelectric line on ECG after the delivery of cardioplegia was reached with warm blood cardioplegia (group 3, 33.9 sec. on average) in contrast to the longest time achieved with Bretschneider HTK (group 2, 91.3 sec. on average).
The worst suppression of the myocardial activity during the cross clamp time (electrical and physical activity) was also observed in group 2 in comparison with the three other groups. The spontaneous heart rhythm after the restoration of myocardial perfusion was most frequently sinus rhythm when blood cardioplegia was used (group 3 - 91.18 %, group 4 - 73.17 %), consequently a greater proportion of patients from groups 2 (83.33 %) and 1 (65.22 %) required defibrillation.