Myocardial Protection With Combined Selective Profound Hypothermia and Hyperkaliemic Cardioplegic Arrest In Aortic Valve Replacement

Abstract

To analyse the results of combined profound myocardial hypothermia and cardioplegic hyperkalemic arrest for aortic valve replacement a series of 100 consecutive patients undergoing isolated or combined aortic valve replacement was reviewed.

There was no operative or early postoperative mortality, only one patient presented with low cardiac output syndrome.

Inotropic support was used in 8, vasodilator therapy in 4 and external pacing in 8 instances. Reoperation for bleeding occurred twice. Postpericardiotomy syndrome was present in 7 patients; requiring surgical drainage in 2. Conduc tion defects ( > 48 H) were present in 3 and supraventricular arrhythmias in 15 patients successfully treated with medical therapy in 5 and D.C. countershock in 10.

The clinical results confirm that this simple myocardial protection technique provides an excellent myocardial preservation for all patients operated for sin gle or combined aortic valve replacement.

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References

Olin LD , Bomfim V. , Bendz R. , et al: Myocardial protection during aortic valve replacement. J Thorac Cardiovasc Surg 82: 837-847, 1981.

Stiles GE , Kirklin JW : Myocardial preservation symposium. J Thorac Cardiovasc Surg 82: 870-877, 1981.

Bleese N. , Döring V. , Kalmer P. , et al: Clinical application of cardioplegia in Aortic cross-clamping periods longer than 150 minutes. Thorac Cardiovasc Surgeon 27: 390-393, 1979.

Primo G. , Cham B. , Leclerc JL : Hypothermie selective profonde pour la protection peroperatoire du myocarde ischemique. Bull Acad Méd Bel 131: 265-276, 1976.

Daggett WM , Jacocks M. , Coleman WS , et al: Myocardial temperature mapping. J Thorac Cardiovasc Surg 82: 883-888, 1981.

Leclerc JL , Deuvaert FE , Wellens F. , et al: A four year experience of bioprosthetic valve replacement. Early and late results. In: Bioprosthetic valves. Immenstädt Algaü, Eberl GMBH, 1978, pp. 27-38.

Leclerc JL , Wellens F. , Deuvaert FE , Primo G. : Longterm results with the St Jude valve. In: Advances in Cardiac Valves. Yorke Medical Books, 1983, pp. 33-40.

Force JL , Raabe DS , Coffin L. , De Mentes JD : Coronary ostial stenosis following aortic valve replacement without continuous coronary perfusion. J Thorac Cardiovasc Surg 80: 637-641, 1980.

Pennington DG , Dincer B. , Bashiti H. , et al: Coronary artery stenosis following aortic valve replacement and intermittent intracoronary cardioplegia. Ann Thor Surg 33: 6, 576-584, 1982.

10.

Flameng W. , Borgers M. , Daenen W, Thoné , et al: St Thomas cardioplegia versus topical cooling: ultrastructural and biochemical studies in humans. Ann Thor Surg 31: 4, 339-346, 1981.