Thorac Cardiovasc Surg 1981; 29(4): 223-226
DOI: 10.1055/s-2007-1023481
© Georg Thieme Verlag Stuttgart · New York

The Effect of Prolonged Cardioplegic Arrest on Long-term Ventricular Function*

R. M. Engelman, R. E. Gianelly, J. H. Rousou, S. M. Zu'bi
  • Baystate Medical Center, Springfield, Massachusetts, USA, and the University of Connecticut Health Center, Farmington, Connecticut, USA
*Supported in part by Grant #1 RO1 HL 22559-02 from the National Institutes of Health, Grant # 80-895 from the American Heart Association, and the Baystate Medical Center, Cardiac Surgery Research Fund.
Further Information

Publication History

1981

Publication Date:
28 May 2008 (online)

Summary

Twenty-five patients (15 coronary revascularizations and 10 valve replacements) having ischemic arrest times longer than 120 minutes (121 to 184 mini were studied by scintigraphy 7 to 27 months after operation. We sought to define if prolonged cardioplegic arrest could be correlated with late postoperative ventricular functional deterioration. Each patient had serial enzymes, EKG analyses, and a technetium pyrophosphate (PYP) scan immediately following operation to determine if an intraoperative infarct occurred which could predispose to functional deterioration.

One coronary bypass patient (6.7%) suffered a perioperative myocardial infarct. After a follow-up period of 7 to 25 (mean 17.9) months, none of the 15 patients has developed recurrent angina, infarction or congestive heart failure. Comparing preoperative and late postoperative ventricular function, 3 patients (20%) had a > 10% fall in ejection fraction (EF) and 3 (20%) a > 10% rise. Mean EF (15 patients) prior to operation was 57.8 ± 4.7 % and at restudy 59.0 ± 4.6 %.

One valve replacement patient (10%) suffered a perioperative infarction. After a follow-up period of 16 to 27 (mean 19.9) months, all patients continue to do well. Comparing preoperative to late postoperative ventricular function, 3 patients (30 %), had a > 10 % fall in EF and 2 (20 %) a > 10 % rise. Mean EF (10 patients) prior to operation was 60.5 ± 5.0% and at restudy 60.1 % ± 5.8%.

It is concluded that prolongation of cardioplegic arrest beyond 2 hours is well-tolerated in most patients. Routine early postoperative tests were not useful in prognosticating late functional deterioration in 4 of 6 patients not suffering a perioperative infarction, and in these patients depressed function may be secondary to myocardial fibrosis.

    >