Brazilian Journal of Cardiovascular Surgery (Aug 1991)
Estudo prospectivo e randomizado entre cardioplegia sangüínea com reperfusão quente (37ºC) e o pinçamento intermitente da aorta na revascularização do miocárdio Randomized controlled trial between blood cardioplegia with warm reperfusion and intermittent aortic cross-clamping in myocardial revascularization
Abstract
No Instituto do Coração, foi realizado um estudo prospectivo e randomizado entre a utilização de cardioplegia sangüínea com reperfusão aquecida e enriquecida com aspartate e glutamato e o pinçamento intermitente da aorta na revascularização do miocárdio. Sessenta pacientes foram operados, sendo 30 com cardioplegia (Grupo C) e 30 com pinçamento intermitente da aorta (Grupo P). Não houve diferenças quanto aos antecedentes patológicos e as condiçõs clínicas pré-operatórias. Quinze pacientes estavam em classe funcional III ou IV (Angina) no grupo C e 20 no grupo P. Seis pacientes apresentavam aneurisma do ventrículo esquerdo, três em cada grupo, e nove pacientes eram reoperações. No grupo C foi realizada uma média de 2,93 enxertos por paciente e no grupo P de 3,13. O tempo de circulação extracorpórea no grupo P foi de 85 ± 23 min e no grupo C de 100 ± 2 8 min (p A prospective and randomized study was performed to compare blood cardioplegia with warm reperfusion to intermittent aortic cross-clamping in the myocardial revascularization. Sixty patients were operated upon, 30 with blood cardioplegia (Group I) and 30 with aortic cross-clamping (Group II). There were no differences between the two groups in regard to preoperative data. Fifteen patients were in NYHA class III or IV (angina) in the group I and 20 patients in the group II. Six patients had left ventricular aneurysms, three in each group. An average number of 2.93 grafts per patient were performed in the group I and 3.13 in the group II. The cardiopulmonary bypass time was 85 ± 23 min in the group II and 100 ± 28 min in the group I (p < 0.05). The aortic cross-clamping time was 44.3 ± 14.9 min in the group II and 62.8 ± 24.5 min in the group I (p < 0.01). The average ischemic time per anastomosis in the group II was 8.6 ± 2.2 min. The postoperative variations of the cardiac index, left ventricular stroke work index and right ventricular stroke work index were similar in the two groups. The higher serum level of CKMB was 30.7 ± 12.8 UI in the group II and 25 ± 10 in the group I. The hospital mortality was 3.3%, one patient in each group. From these findings, we conclude that both techniques offer good myocardial protection and are used in the myocardial revascularization with similar results.
