Warm Versus Cold Cardioplegia for Myocardial Protection in Coronary Artery Bypass Surgery: A prospective Comparative Study.

Background: Although both warm blood and cold crystalloid cardioplegia are frequently used to induce electromechanicalarrest, it is unclear whether is more useful in clinical settings. These two cardioprotectives were compered in patientshaving coronary artery bypass grafting (CABG) in a prospective comparative research.Patients and Methods: A total of 50 people (30–70 years old) receiving isolated CABG at two tertiary centres in Egyptwere the patients of our study. Depending on the surgeon’s option, patients were either given intermittent antegrade cold(4°C) crystalloid cardioplegia (n=25) or intermittent antegrade warm (34–35°C) blood cardioplegia (n=25). Myocardialenzyme release (creatine kinase [CK], CK-MB, and troponin I) measured 48h after surgery was the main outcome.Intraoperative, postoperative, and 3-month outcomes were examples of secondary endpoints.Results: There were no significant differences between groups in cardiopulmonary bypass or cross-clamp times (P>0.05for both). Postoperatively, CK-MB levels were lower at 48h with cold crystalloid cardioplegia (mean 21.7 vs. 29.1ng/mlfor warm blood, P=0.041). However, CK and troponin I profiles were similar between groups (P>0.05). No differenceswere demonstrated in duration of ventilation, ICU length of stay, or requirements for inotropes or IABP support (P>0.05for all). The cold crystalloid group showed higher rates of postoperative cardiac events (37.5 vs. 12.5%, P=0.046) andabnormal echocardiographic wall motion at 3 months (34.8 vs. 8.7%, P=0.032). After adjustment for baseline renalfunction and glycemic control, the cardioplegia strategy was not an independent predictor of death or major adversecardiac events.Conclusion: Clinical results showed that neither cold crystalloid cardioplegia nor warm blood cardioplegia was better forprotecting the heart in patients having CABG. These results underline the necessity of more extensive, conclusive studiesassessing myocardial management techniques in heart surgery.