CONTINUOUS RETROGRADE COLD BLOOD CARIOPLEGIA DECREASES THE INCIDENCE OF PERIOPERATIVE ARRHYTHMIAS IN PATIENTS UNDERGOING ISOLATED CORONARY ARTERY BYPASS GRAFTING.

Abstract

Objective: To show the effect of continuous cold retrograde blood cardioplegia on the recovery of the
heart and on the incidence of perioperative arrhythmias in patients undergoing isolated coronary artery
bypass grafting.
Patients and methods: This is a prospective study done on two groups of patients who underwent on pump
coronary artery bypass grafting for isolated coronary artery disease between January 2009 and January
2011, each group consists of 134patients, well matched regarding age, sex, weight, EuroScore, and
number of grafted vessels. In group one myocardial preservation was done by infusion of single dose cold
crystalloid cardoplegia antegradely and continuous cold blood cardoplegia retrogradely all through the
procedure, in group two this was done by single dose crystalloid cardioplegia followed by intermittent
doses of cold blood cardoplegia retrogradely.
Results: spontaneous recovery of heart beat into sinus rhythm after removal of the aortic cross clamp was
observed in 120/134 patients (90%) in group one compared to 101/134 patients (75%) in group two
(P=0.004). 14 patients need defibrillation in group one, whereas this was needed in 33 patients in group 2
(P=0.002).In the postoperative period 3 patients(2%) in group one and 5 patients(4%) in group 2(P=0.47)
remained in atrial fibrillation regardless defibrillation and amiodarone and magnesium sulphate infusion
whereas transient atrial fibrillation was noticed in 4 patients(3%) in group one and six patients (4.5%)in
group two(P=0.5).
Conclusion: It seems that with continuous retrograde cold blood cardioplegia the chances for spontaneous
recovery of the heart into sinus rhythm is more and the incidence of perioperative arrhythmia is less.
Key words: CABG, Cardioplegia, Perioperative arrhythmias