Assessment of protective effects of Warm Terminal Blood Cardioplegia on Myocardial Protection in CABG

Introduction: Coronary artery disease A significant metabolic derangement occurs in the ischaemic-reperfused heart of patients undergoing coronary artery bypass surgery using cold blood cardioplegia . It has been reported that up to one forth of deaths after coronary artery bypass grafting surgery may be caused by Reperfusion injury especially in patients with higher NYHA classes. There are evidences that in adult cardiac operations, a warm cardioplegic reperfusate (hot shot) before removing the aortic cross-clamp improves postbypass myocardial function and metabolic recovery . We randomly assigned 41 consecutive patients undergoing primary, elective CABG into two groups; TWBC Group who received Terminal Warm Blood Cardioplegia just before removing of Aortic cross clamp (n=24) and second group (Control) did not received TWBC (n=17). Among patients in CONTROL group 41% (95% CL: 19-62%) received at least one inotrope, but only 17% (95% CL: 0 - 35%) of patients in TWBC group did so (p = 0.085). Also in respect to EF there was superiority in TWBC group only in patients with low pre operative EF. There was higher rate of spontaneous beating in TWBC group (21 of 24 or 88%) versus Control group (12 of 17 or 70%; P 0.1). Conclusion: it seems prudent to routinely use Terminal Warm Blood Cardioplegia in patients undergoing coronary bypass graft especially in those with reduced ventricular function.