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November 1976

Selective Intracavitary and Coronary Hypothermic Cardioplegia for Myocardial Preservation: Clinical, Physiologic, and Ultrastructural Evaluation

Author Affiliations

From the Departments of Surgery and Pathology, School of Medicine, State University of New York at Buffalo and the Buffalo General Hospital. Dr Schachner is a Visiting Cardiac Fellow of the Belinson Medical Center, Tel Aviv University, Israel.

Arch Surg. 1976;111(11):1197-1209. doi:10.1001/archsurg.1976.01360290031005

• Intraoperative myocardial protection was evaluated in two groups of patients undergoing coronary surgery in whom different techniques for cardiac arrest were utilized. In group A, profound selective myocardial hypothermic (15 to 18 C) arrest was achieved by perfusing a coolant (7 to 10 C) into the left ventricular cavity and the coronary circulation. The average anoxic arrest time was 82.5 ± 27 minutes. In group B, ventricular fibrillation and moderate hypothermia were used. Group A patients showed rapid physiologic recovery, low average myocardial creatinine phosphokinase (MB-CK) isoenzyme levels (7.8 IU), and a well-preserved myocardial ultrastructure. In group B, three patients showed abnormal physiologic recovery; six patients needed postoperative inotropic support; and in seven patients, electron-microscopy revealed irreversible focal changes. The average MB-CK isoenzyme level was 85.6 IU.

Analysis of our data demonstrates that when myocardial protection during coronary bypass grafting is achieved by selective profound intracavitary and coronary cooling, there is physiological, ultrastructural, and biochemical evidence of less intraoperative myocardial damage than when ventricular fibrillation is applied.

(Arch Surg 111:1197-1209, 1976)

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