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Vol.3 - No.3

Warm-blood cardioplegia with low or high magnesium for coronary bypass surgery:a randomised controlled trial

By : baghaei

Keywords : Myocardial protection • Cardioplegia • CABGSurgery • Atrial fibrillation • Flutter

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Objectives

Magnesium (Mg2+) is cardioprotective and has
been routinely used to supplement cardioplegic solutions
during coronary artery bypass graft (CABG) surgery. However,
there is no consensus about the Mg2+ concentration
that should be used. The aim of this study was to compare the
effects of intermittent antegrade warm-blood cardioplegia
supplemented with either low- or high-concentration Mg2+.

Methods

This study was a randomised controlled trial carried
out in two cardiac surgery centres, Bristol, UK and Cuneo,
Italy. Patients undergoing isolated CABG with cardiopulmonary
bypass were eligible. Patients were randomised
to receive warm-blood cardioplegia supplemented with 5
or 16 mmol l-1 Mg2+. The primary outcome was postoperative
atrial fibrillation. Secondary outcomes were serum
biochemical markers (troponin I, Mg2+, potassium, lactate
and creatinine) and time- -plegia arrest. Intra-operative and
postoperative clinical outcomes were also recorded.

Results

Data from two centres for 691 patients (342 lowand 349 high Mg2+) were analysed. Baseline characteristics
were similar for both groups. There was no significant
difference in the frequency of postoperative atrial fibrillation
in the high (32.8%) and low (32.0%) groups (risk ratio
1.03, 95% confidence interval, CI, 0.82-1.28). However,
compared with the low group, troponin I release was 28%
less (95% CI 55-94%, p = 0.02) in the high-Mg2+ group.
The 30-day mortality was 0.72% (n = 5); all deaths occurred
in the high-Mg2+ group but there was no significant difference
between the groups (p = 0.06). Frequencies of other
major complications were similar in the two groups.

Conclusion

Warm-blood cardioplegia supplemented with
16 mmol l-1 Mg2+, compared with 5 mmol l-1 Mg2+, does
not reduce the frequency of postoperative atrial fibrillation
in patients undergoing CABG but may reduce cardiac injury.
(This trial was registered as ISRCTN95530505.)

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