Surgically induced ischemia and reperfusion injury continue to be a major contributor to
morbidity and mortality after open heart surgery. Data about myocardial protection in high risk
patients undergoing coronary artery bypass grafting (CABG) is scarce.
Objective To evaluate the best technique of cardioplegic myocardial protection in high risk patients
undergoing isolated or combined CABG and to assess the effect of giving warm (hot) shot
cardioplegia before cross clamp removal on the immediate outcome of those patients.
Methods Seventy-two patients who underwent either isolated or combined CABG at a tertiary
care center in Saudi Arabia between January 2007 and July 2010 were enrolled. Data was
prospectively and retrospectively collected and analyzed. The study populations are high
risk patients (determined as simple additive EuroSCORE of 6 or more) for coronary artery
bypass grafting. Patients are randomized into two groups comparing cold blood cardioplegia
followed by warm shot as study group, and the control group using cold blood cardioplegia
with no warm shot. The data collected included preoperative demographic and clinical
characteristics, intraoperative data and postoperative short term outcome including inhospital
mortality.
Results A total of 72 patients were enrolled in 2 groups, hot shot group (group I, 32 patients)
and non hot-shot patients group (group II, 40 patients). Patients receiving hot shots versus
those not receiving hot shots were found to have significantly better outcome including fewer
ventricular arrhythmias needing electric shock defibrillation (6.25% versus 17.55%, P= 0.005),
intra-operative need of IABP (0% versus 5%, P |
