Comparison of cardioprotective properties of artificial electrical fibrillation of the heart and Bretschneider solution during coronary artery bypass grafting

O.A. Loskutov, O.M. Druzhyna, D.O. Dzyuba, S.V. Pashchenko


Background. The problem of ischemic damage to the myocardium during cardiac surgery is still far from its final solution. So, depending on the method of cardioprotection, the incidence of intraoperative myocardial infarction is 2–7.2 %, acute heart failure — 2.7–51.2 %, severe cardiac rhythm disturbances — 20–63.6 %. The objective was to study the comparative efficacy of the cardioprotective effect of artificial electrical fibrillation of the heart and the Bretschneider solution when performing coronary artery bypass grafting with cardiopulmonary bypass. Materials and methods. One hundred eighteen patients with coronary heart disease participated in the study, they underwent coronary artery bypass grafting with cardiopulmonary bypass at the premises of Heart Institute of the Ministry of Health of Ukraine (Kyiv). In 58 patients (group I), we used artificial electrical fibrillation of the heart, in 60 persons (group II) — the cold chemical cardioplegia using Bretschneider solution. Results. A comparative analysis of local cardioprotection effectiveness showed a statistically significant difference in the mean blood pressure between the two study groups in the post-perfusion period (p = 0.003572). Meanwhile, the mean blood pressure in group I was 22.1 ± 1.2 % higher compared to that of group II. Also, the stroke volume index in group I was 48.90 ± 1.34 ml/m2, that is 21.30 ± 1.21 % higher than in group II for the same period (p < 0.05). The ejection fraction, which was 19.00 ± 1.14 % (р < 0.05) lower in group ІІ compared to group I during the post-perfusion period, subsequently, by the end of surgery, restored to 49.20 ± 1.35 % and had no statistically significant difference with group I (p = 0.4235). The incidence of arrhythmias in group I was 17.2 %, that is 7.2 % higher than in group II. Determination of comparative activity of troponin I at all stages of observation did not reveal a statistically significant difference between groups. Conclusions. Local cardioprotection using artificial electrical fibrillation of the heart, compared to cold chemical cardioplegic protection of the myocardium with Bretschneider solution, can provoke greater arrhythmogenic activity but more consistently maintains the myocardial contractility and provides a reliable level of cardioprotection.


cardioprotection; electrical fibrillation of the heart; Bretschneider solution; coronary artery bypass grafting


Characteristics and baseline clinical predictors of future fatal versus nonfatal coronary heart disease events in older adults: the Cardiovascular Health Study / C.A. Pearte, C.D. Furberg, E.S. O’Meara [et al.] // Circulation. — 2006. — Vol. 113. — № 18. — Р. 2177-2185.

Does intermittent cross-clamp fibrillation provide equivalent myocardial protection compared to cardioplegia in patients undergoing bypass graft revascularisation? / M. Scarci, H.B. Fallouh, C.P. Young, [et al.] // Interact. cardiovasc. thorac. surg. — 2009. — Vol. 9, № 5. — Р. 872-878.

Hausenloy D.J. Cardioprotection during cardiac surgery / D.J. Hausenloy, E. Boston-Griffiths, D.M. Yellon // Cardiovasc. Res. — 2012. — Vol. 94, № 2. — P. 253-265.

Heart disease and stroke statistics-2011 update: A report from the american heart / V.L. Roger, A.S. Go, D.M. Lloyd-Jones [et al.] // Circulation. — 2011. — Vol. 123. — e18-e209.

Is there any difference between blood and crystalloid cardioplegia for myocardial protection during cardiac surgery? A meta-analysis of 5576 patients from 36 randomized trials / M. Sá, F. Rueda, P. Ferraz [et al.] // Perfusion. — 2012. — Vol. 27, № 6. — Р. 535-546.

Suleiman M.S. Inflammatory response and cardioprotection during open-heart surgery: the importance of anaesthetics / M.S. Suleiman, K. Zacharowski, G.D. Angelini // Br. J. Pharmacol. — 2008. — Vol. 153, № 1. — P. 21-33.

Coronary artery bypass grafting: 30-day operative morbidity analysis in 1046 patients / N.R. Alwaqfi, Y.S. Khader, K.S. Ibrahim [et al.] // J. Clin. Med. Res. — 2012. — Vol. 4, № 4. — P. 267-273.

30-day readmissions after coronary artery bypass graft surgery in New York State / E.L. Hannan, Y. Zhong, S.J. Lahey [et al.] // JACC Cardiovasc. Interv. — 2011. — Vol. 4, № 5. —

P. 569-576.

http://xn--d1aiegmcrih.xn--p1ai/instruction.php — офіційна інструкція до застосування препарату.

Hypothermia to reduce neurological damage following coronary artery bypass surgery / K. Rees, M. Beranek-Stanley, M. Burke, S. Ebrahim // Cochrane Database of Systematic Reviews. — 2001. — Issue 1. — Art. No.: CD002138.

Edelman J.J., Seco M., Dunne B. et al. Systematic review protocol: single-dose histidine-tryptophan-ketoglutarate vs. intermittent crystalloid or blood cardioplegia // Ann. Cardiothorac. Surg. — 2013. — 2. — 677.

Хапаев Т.С., Архипов А.Н., Омельченко А.Ю., Зубрицкий А.В., Лукьянов А.А., Горбатых А.В., Наберухин Ю.Л., Горбатых Ю.Н. Закрытие дефектов межпредсердной перегородки из мидаксиллярной боковой мини-торакотомии в условиях индуцированной фибрилляции желудочков // ПКиК. — 2015. — № 2.

Copyright (c) 2019 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2020


   Seo анализ сайта