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European Journal of Cardio-Thoracic Surgery, Vol 12, 254-260, Copyright © 1997 by European Association for Cardio-thoracic Surgery
M Caputo, W Dihmis, I Birdi, B Reeves, MS Suleiman, GD Angelini and AJ Bryan
OBJECTIVE: To evaluate and compare myocardial protection using cold
crystalloid and blood cardioplegia by measuring release of cardiac Troponin
T and Troponin I during coronary artery surgery. METHODS: Forty two
patients undergoing myocardial revascularization were prospectively
randomised into two groups in whom myocardial protection was achieved with
either antegrade cold (4 degrees C) crystalloid (CCP) (n = 21) St. Thomas'
I cardioplegic solution. Serial venous blood samples were collected for
measurement of cardiac Troponin T and Troponin I, prior to induction of
anesthesia and at 4, 12, 24 and 48 h after removal of the aortic cross
clamp. RESULTS: There were no hospital deaths in the two groups and one
patient in each group suffered a perioperative myocardial infarction.
Rising levels of Troponin T and Troponin I were found in all patients.
Serum concentrations increased as early as 4 h after removal of the aortic
cross clamp, and reached a peak at 12 h postoperatively in both groups.
These levels subsequently declined, but remained higher than preoperative
values at 48 h. There were no differences between the two groups with
respect to serum Troponin T and I release at 4, 12, 24 and 48 h, area under
the respective curves, and peak Troponin T and I release. Serum Troponin
levels were significantly higher in patients with unstable angina and in
two patients who suffered a perioperative myocardial infarction.
CONCLUSION: Serum release of cardiac Troponin T and Troponin I is
significantly raised in low risk patients undergoing myocardial
revascularization. This release is similar when either cold crystalloid or
cold blood cardioplegia are used. This may imply that both methods offer
identical protection to the myocardium in a low risk group of patients.
ARTICLES
Cardiac troponin T and troponin I release during coronary artery surgery using cold crystalloid and cold blood cardioplegia
Bristol Heart Institute, Bristol Royal Infirmary, UK.
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