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Eur J Cardiothorac Surg 1999;15:67-74
© 1999 Elsevier Science NL
a Department of Cardiothoracic Surgery, University of Cologne; Joseph Stelzmannstr. 9, 50924 Cologne, Germany
b Department of Cardiology, University of Cologne; Joseph Stelzmannstr. 9, 50924 Cologne, Germany
c Department of Anesthesiology, University of Cologne; Joseph Stelzmannstr. 9, 50924 Cologne, Germany
d Department of Pharmacology, University of Cologne; Joseph Stelzmannstr. 9, 50924 Cologne, Germany
Received 22 September 1998; received in revised form 10 November 1998; accepted 25 November 1998.
Corresponding author. Tel.: +49-221-478-6043; fax:+49-221-478-5906; e-mail: ferdinand.kuhn-regnier@medizin.uni-koeln.de
Objective: Continuous perfusion of the coronary arteries with ß-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 ß-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<0.05); FAC: ES: 55±3 versus BC: 48±3% (P<0.05). HSP-70 and actin pattern showed no difference between groups; however, ICAM-I showed a significantly higher degree of structural changes in BC hearts: 18±2 versus ES: 11±1% (P<0.05). Conclusion: Our data demonstrate that application of the ß-blocker technique during routine CABG was associated with slightly better functional recovery and less structural myocardial alteration as compared with intermittent cold blood cardioplegia, however, both techniques provided equivalent myocardial protection in terms of patient outcome. Future studies are required to investigate if myocardial ischemia minimization by use of the ß-blocker technique may be beneficial in compromized hearts.
Key Words: Beta-blocker • Esmolol • Myocardial protection • Blood cardioplegia • Coronary surgery • Intercellular adhesion molecule • Cardiopulmonary bypass
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