Is there a place for cold crystalloid cardioplegia in the 1990s?

Abstract

New cardioplegic techniques have been advocated as advantageous when compared with previously accepted standard methods. This study assessed results of a recent cohort of 388 consecutive patients undergoing coronary artery bypass grafting between 1990 and 1992 using a standard cold crystalloid cardioplegia. The mean age of patients was 61.0 +/- 0.5 years; there were 324 male and 64 female patients. Risk factor distribution has not changed recently. Preoperative left ventricular dysfunction (grade III/IV) was significant in 35.1% of patients, and 63.3% had previous myocardial infarctions. Intraoperative cardiac arrest was achieved using an average of 1,254 +/- 14 mL of St. Thomas' solution in multiple doses. Patients had a mean of 3.1 +/- 0.04 grafts constructed, with 87.7% receiving at least one internal thoracic artery graft. Anoxia and total cardiopulmonary bypass times were 40.6 +/- 0.6 and 90.3 +/- 1.4 minutes, respectively. Perioperative myocardial infarction was identified in 5.7% of patients with elevated creatine kinase levels and electrocardiographic measurement changes, inotropic agents were required in 17.8%, and the intraaortic balloon was required in 3.6% of patients. Hospital stays averaged 11.2 +/- 0.5 days. Overall 30-day mortality was 1.0%, whereas those patients undergoing elective operation (n = 219) had a mortality of 0%. In conclusion, cold crystalloid cardioplegia has the advantages of being inexpensive and simple to use. These results suggest that coronary artery bypass grafting still may be performed very safely using this technique.