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A comparison of ischemic preconditioning versus terminal warm cardioplegia with controlled reperfusion in open heart operation.

BACKGROUND: The purpose of this study was to evaluate the effects of three different methods of cardioprotection in patients undergoing valve replacement. METHODS: Ninety patients undergoing elective valve replacement were randomly divided into three groups. In group 1 (n=30), the patients received intermittent cold blood cardioplegia. In group 2 (n=30) they received terminal warm cardioplegia and controlled reperfusion, and in group 3 (n=30), the patients received two cycles of ischemia (2 minutes) and reperfusion (3 minutes) before heart arrest induced by cold blood cardioplegia. The parameters of cardiac function, creatine kinase MB, and clinical outcomes were recorded to assess the effects of experiment. RESULTS: The major preoperative and intraoperative variables are comparable within the three groups. The number of patients requiring the support of inotropic agents was 70% (21/30), 33% (11/30) and 40% (12/30) in group 1, 2 and 3, respectively (p<0.05). The doses of inotropic agent in groups 2 and 3, were significantly lower than in group 1 (1.5+/-0.3 and 1.8+/-0.4 versus 4.5+/-0.8 microg x kg x min(-1), p<0.01) during the first 24 hours after operation. Two deaths (30 day-hospital mortality) occurred, one in group 1 and one in group 2. The cardiac index at 2 hours after bypass discontinuing were 2.2+/-0.04, 3.0+/-0.1 and 2.8+/-0.05 L/m(2) in group 1, 2 and 3, respectively (p<0.01). The left ventricular stroke work index were 24.8+/-1.3, 34.5+/-1.6 and 31.6+/-1.2 g/m x m(2) in group 1, 2, 3, respectively (p<0.01). The release of CK-MB in group 2 and 3 were lower than in group 1 (68+/-7, 81+/-9 versus 116+/-10 IU/L, p<0.01). CONCLUSIONS: Terminal warm cardioplegia with controlled aortic root reperfusion and ischemic preconditioning equally improve cardiac function and reduce the requirement of inotropic agents in patients undergoing valve replacement.