Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Cardiothoracic Surgery

Background : Myocardial protection has a major impact on the postoperative outcome of patients undergoing cardiac surgery with the use of extracorporeal circulation . Myocardial protection is mainly achieved by administration of cardioplegic solution ,Therefore it is essential to achieve an adequate and effective method of cardioplegia. Methods : We evaluate post-operative cardiac Troponin I (cTnI) release, low cardiac output syndrome (LCOS) and mortality, using a cold crystalloid single- dose intracellular or cold blood multidose cardioplegia in 100 elective or emergent thoracic aorta operation patients. Fifty patients (HTK group) received Custodiol cardioplegic solution and fifty received cold blood cardioplegia (CB group). Results: cTnI peak release , duration of inotropic support & intensive care unit (ICU) stay was more in the cold blood group . Hemofiltration and intraoperative requirement of blood products transfusion was more in the HTK group. No differences were found for Cross-clamp time, cardiopulmonary bypass (CPB) , atrial and ventricular arrhythmias, postoperative ejection fraction (EF) & LCOS and in-hospital mortality. Conclusion: HTK and CB cardioplegic solutions assure good myocardial protection in patients undergoing thoracic aorta operations. In long cross-clamp times, the lower post-operative cTnI release detected using HTK may be indicative of a better myocardial protection in these extreme conditions

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