Beta-blockade versus Buckberg blood-cardioplegia in coronary bypass operation

Objective: Continuous perfusion of the coronary arteries with β-blocker (esmolol)-enriched normothermic blood during cardiac surgery has been suggested as an alternative technique for myocardial protection. The aim of the present study was to compare the β-blocker technique to Buckberg's blood...

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Bibliographic Details
Published in:European journal of cardio-thoracic surgery 1999-01, Vol.15 (1), p.67-74
Main Authors: Kuhn-Régnier, Ferdinand, Natour, Ehsan, Dhein, Stefan, Dapunt, Otto, Geissler, Hans J., LaRosé, Karl, Görg, Christoph, Mehlhorn, Uwe
Format: Article
Language:English
Subjects:
Adrenergic beta-Antagonists - administration & dosage
Aged
Beta-blocker
Blood cardioplegia
Cardiopulmonary bypass
Cardiopulmonary Bypass - methods
Coronary Artery Bypass - methods
Coronary surgery
Esmolol
Female
Follow-Up Studies
Heart Arrest, Induced
Heart Ventricles - metabolism
HSP70 Heat-Shock Proteins - metabolism
Humans
Hypothermia, Induced
Infusions, Intravenous
Intercellular adhesion molecule
Intercellular Adhesion Molecule-1 - metabolism
Intraoperative Period
Male
Middle Aged
Myocardial Ischemia - drug therapy
Myocardial Ischemia - physiopathology
Myocardial Ischemia - surgery
Myocardial protection
Postoperative Complications - prevention & control
Propanolamines - administration & dosage
Prospective Studies
Treatment Outcome
Ventricular Function, Left - drug effects
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Summary:Objective: Continuous perfusion of the coronary arteries with β-blocker (esmolol)-enriched normothermic blood during cardiac surgery has been suggested as an alternative technique for myocardial protection. The aim of the present study was to compare the β-blocker technique to Buckberg's blood cardioplegia during coronary artery bypass grafting (CABG). Methods: Sixty patients with coronary artery disease were randomly assigned to either the esmolol group (ES, n=30) or the blood cardioplegia group (BC, n=30). During aortic cross-clamp ES patients received continuous normothermic coronary perfusion with esmolol-enriched blood. Hearts of the BC group were protected by antegrade cold blood cardioplegia according to Buckberg. We measured left ventricular (LV) contractility using TEE (fractional area of contraction, FAC) and hemodynamic parameters prior to cannulation for cardiopulmonary bypass (CPB), after decannulation, and 4 h postoperatively. Myocardial lactate release was measured prior to aortic cross-clamp, during cross-clamp, and after decannulation. LV biopsies for determination of heat-shock protein (HSP-70), actin pattern and intercellular adhesion-molecule (ICAM-I) as indicators for structural changes were collected prior CPB, at the end of the aortic cross-clamp period, and prior to weaning off CPB. Results: There was no significant difference between both groups with respect to grafts and cross-clamp time. ES hearts did not release lactate during cross-clamp. In contrast, BC hearts released significant amounts of lactate. Post CPB FAC and hemodynamics under similar inotropic stimulation showed no difference between groups, whereas at 4 h post CPB measurements showed slightly better values in the ES group: cardiac index: ES: 2.9±0.1 (SEM) versus BC: 2.6±0.1 L/min per m2 (P
ISSN:1010-7940
1873-734X
DOI:10.1016/S1010-7940(98)00289-9