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