Beneficial Effect of Terminal Warm Blood Cardioplegia and Controlled Aortic Root Reperfusion during Isolated Aortic Valve Replacement.
10.4326/jjcvs.23.424
- VernacularTitle:大動脈弁置換術におけるｔｅｒｍｉｎａｌ ｗａｒｍ ｂｌｏｏｄ ｃａｒｄｉｏｐｌｅｇｉａの有効性に関する検討
- Author:
Hajime Otani
;
Tokumitsu Ko
;
Yasushi Kato
;
Yoshiya Sakurai
;
Kazuho Tanaka
;
Michio Fukunaka
;
Hiroji Imamura
- Publication Type:Journal Article
- Keywords:
terminal warm blood cardioplegia;
controlled aortic root reperfusion
- From:Japanese Journal of Cardiovascular Surgery
1994;23(6):424-428
- CountryJapan
- Language:Japanese
-
Abstract:
Left ventricular hypertrophy in patients with aortic valve disease has long been recognized as a significant risk factor for aortic valve replacement. Higher operative mortality in such patients has been attributed to poor myocardial preservation. In these patients improvement of left ventricular subendocardial blood flow during reperfusion seems to be mandatory to avoid subendocardial injury. Therefore, we attempted to increase subendocardial blood flow during reperfusion by terminal warm blood cardioplegia (TWBCP) followed by controlled aortic root reperfusion (CARR) in patients requiring isolated aortic valve replacement. The patients with TWBCP and CARR had a tendency towards severe left ventricular hypertrophy and more advanced NYHA function class compared to those with hypothermic cardioplegia alone. Nevertheless, the patients with TWBCP and CARR showed significantly better recovery of left ventricular function, i.e., spontaneous recovery of beating and higher cardiac index as well as left ventricular stroke work index, despite significantly less catecholamine support. These resuls suggest that TWBCP followed by CARR may offer significant benefits over unmodified reperfusion during aortic valve replacement for patients with severe left ventricular hypertrophy.
