Assessment of continuous cold blood cardioplegia in coronary artery bypass grafting

BACKGROUND: A method of cold blood cardioplegia (CBCP) delivered continuously and in a retrograde manner was compared with methods differing only by their rate (intermittent) or way (antegrade) of administration. METHODS: This study comprises 298 consecutive patients undergoing isolated coronary artery bypass grafting procedures performed by the same surgeon from 1992 to 1995. Three-vessel disease characterized 58.8% of the cases, and the left ventricular ejection fraction was less than 0.40 in 22.8%. In group I (n = 100), CBCP was administered in an antegrade and intermittent fashion; in group II (n = 87), CBCP was given in a retrograde and intermittent manner; in group III (n = 111), CBCP delivery was retrograde and continuous. RESULTS: The incidence of major cardiac adverse outcome (death or need for intraaortic balloon counterpulsation) was 7.0% in group I, 8.0% in group II, and 0.9% in group III (p = 0.040). Repeated-measures analysis of hemodynamic indices showed a marked superiority of continuous retrograde compared with antegrade intermittent blood cardioplegia regarding left ventricular stroke work index (p < 10(-4)) and compared with both methods of intermittent CBCP regarding right ventricular stroke work index (p < 10(-5)). CONCLUSIONS: The use of continuous CBCP resulted in a significant reduction in major cardiac events, better left ventricular performance, and a marked improvement of right ventricular function in comparison with similar solutions of blood cardioplegia administered intermittently, independent of their way of delivery