Extensive myocardial revascularization - Influence of cardioplegia on operative results

Experience with extensive myocardial revascularization (5 or more distal anastomoses) during a one-year-period is reviewed. Intermittent hypothermic aortic occlusion was used in 68 patients (non-cardioplegia group), and cold cardioplegia in 70 patients. The 2 groups were similar in regard to age, sex, extension of coronary artery disease, number of previous myocardial infarctions, preoperative diagnosis of impending myocardial infarction and preoperative left ventricular function. Five patients in the non-cardioplegia group died early postoperatively, while no cardiac death occurred in the cardioplegia group (p=0.02). The incidence of perioperative infarction and postoperative catecholamine requirement was lower in the cardioplegia group (p-values 0.04 and <0.01 respectively).The major determinant of the postoperative catecholamine requirement in the non-cardioplegia group was the total aortic cross-clamp time, while in the cardioplegia group it was the preoperative left ventricular end-diastolic pressure. A policy of 'complete revascularization' in diffuse coronary artery disease seems to be justified only if cold cardioplegia is used for myocardial preservation.