[HSF] high flowWarm blood cardioplegia versus Salarenos technique

[Ani Anyanwu]

Dear Dr Martin

I am curious to know why your preference is for crystalloid rather than blood cardioplegia.

Thank you

Ani Anyanwu
  ----- Original Message ----- 
  From: tdmartin2000 at aol.com<mailto:tdmartin2000 at aol.com> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Saturday, April 21, 2007 8:13 AM
  Subject: Re: [HSF] high flowWarm blood cardioplegia versus Salarenos technique


  I guess I'll chime in on this discussion. Yes - cardioplegia is your friend. I don't even really worry about clamp times anymore. One of my partners recently had a real disaster of a case with a 4hr clamp time. Pt came off with minimal inotropes and was extubated the next morning. I am a dinosaur and still use crystalloid. Having said all of  that I would have to agree however that ischemia is bad in the literal sense. In the lab, perfused hearts will always look better on the microscopic level than ischemic hearts and in reallity perfused hearts should function better, even if it is only noticeable with subclinical measures. The advantage of the still, flaccid, bloodless heart is in my mind the ease of the operation and the ability to get the best technical result possible. Not to say that surgeons can't learn to get good results with a beating bloody heart, but in many situations, I think the best and easiest technical results are achieved in a still clean operative field. 
   Cardioplegia levels the playing field in many situations.
   
  Tom Martin
  U of Florida
  Gainesville 
   
  -----Original Message-----
  From: Hgrmd at aol.com<mailto:Hgrmd at aol.com>
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
  Sent: Fri, 20 Apr 2007 6:22 PM
  Subject: Re: [HSF] high flowWarm blood cardioplegia versus Salarenos technique


  Michael,
    Your intraoperative myocardial protection plan sounds very similar  to 
  mine.  Today, I operated on a 77 yo lady with a 6.2cm root, 3+ AI, mod  TR, 
  severe 
  2vd, and chronic AF.  I did a biologic Bentall, 1 artery and 2  vein grafts, 
  Cryomaze, and a tricuspid repair.  The clamp time was 3 hrs, 2  minutes.  She 
  came off easily, AV paced, with an EF of 60% on 5mcgs of  dobutamine and some 
  NTG.  The point is there's more than one way to  effectively and safely skin a 
  cat.
  Hal



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