Perfusion deficits with retrograde warm blood cardioplegia (original) (raw)
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Annals of Thoracic Surgery, 1993
Peripheral vasodilation is commonly seen during and after warm heart operations and can become of clinical concern when it requires vasopressors because some of these drugs adversely affect coronary artery bypass graft flows. As hemodilution lowers systemic vascular resistance, we assessed whether peripheral vasodilation could be limited by a drastic reduction of the volume of infused cardioplegia. Fifty patients underwent isolated coronary artery bypass grafting procedures using normothermic (35' to 37°C) bypass and normothermic continuous retrograde blood cardioplegia. They were divided into two equal groups: in group 1, blood was diluted 4:l with hyperkalemic crystalloid cardioplegia, whereas in group 2, the cardioplegic "solution" was limited to the sole arresting agents that were concentrated in a small volume (16 mEq potassium chloride and 3 mEq magnesium chloride in a 20-mL ampoule). This "minicardioplegia" was continuously added to arterial blood so as to keep the heart arrested. The average volume of cardioplegia per patient was 1,000 mL in group 1 and arm heart operation is a recently introduced technique that combines normothermic cardiopulmonary bypass and normothermic continuous blood cardioplegia [I, 21. Whereas several investigators have assessed the consequences of this new type of cardioplegia on myocardial preservation, there has been no detailed study, except for that of Christakis and co-workers [3], addressing the issues raised by the systemic effects of normothermic cardiopulmonary bypass.
Anatomic and hemodynamic considerations influencing the efficiency of retrograde cardioplegia
The Annals of Thoracic Surgery, 2001
cardioplegia Anatomic and hemodynamic considerations influencing the efficiency of retrograde http://ats.ctsnetjournals.org/cgi/content/full/71/4/1389 on the World Wide Web at: The online version of this article, along with updated information and services, is located Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association. One of the major issues raised by cardiac surgical procedures requiring cardiopulmonary bypass is the question of myocardial protection. The preferred route for the administration of cardioplegia is controversial. A number of studies show the beneficial effects of retrograde cardioplegia but some demonstrate only partial or poor myocardial protection. This paper reviews the anatomy and anatomic variations of the coronary sinus, the coronary sinus orifice and cardiac veins, and the major systemic venous drainage, all of which may affect the distribution of retrograde cardioplegia. (Ann Thorac Surg 2001;71:1389 -95) P ratt [1] suggested in 1898 that oxygenated blood could be supplied to an ischemic myocardium through the coronary venous system. In 1956, Lillehei and colleagues [2] used retrograde coronary sinus perfusion to protect the heart during an aortic valve operation. Since then, retrograde coronary sinus cardioplegia (RCP) has gained widespread use as a method of myocardial protection in a broad range of cardiac procedures. The advantages of RCP are (1) the provision of a relatively uniform distribution of cardioplegia even in the presence of severe coronary artery disease which can alter the distribution of antegrade cardioplegia [3, 4
Retrograde continuous warm blood cardioplegia: a new concept in myocardial protection
The Annals of Thoracic Surgery, 1991
This report presents the results in our first clinical series of patients receiving continuous warm blded cardioplegia through the coionary sinus. Warm oxygenated blood cardioplegia has certain theoretical advantages, such as continuously supplying oxygen and substrates to the arrested heart while avoiding the side effects of hypothermia. Retrograde infusion of cardioplegia also offers certain advantages (eg, in valve operations and in patients with severe coronary artery disease) that are complementary to warm blood cardioplegia. Retrograde warm blood cardioplegia was used in 113 consecutive etrograde coronary sinus cardioplegia has been R shown to be safe and effective [l-31. Until recently, its use was somewhat limited because of the difficulties and danger involved in cannulating the coronary sinus for cardioplegia delivery. In 1990, Drinkwater and associates [4] reported the use of a coronary sinus catheter with a self-inflating balloon, which has simplified the technique of coronary sinus cardioplegia. This catheter can usually be inserted into the coronary sinus without the need of direct visualization, and therefore, only rarely will bicaval cannulation and snaring be necessary.
The regional capillary distribution of retrograde blood cardioplegia in explanted human hearts
The Journal of Thoracic and Cardiovascular Surgery, 1995
Warm retrograde blood cardioplegia is frequently used for myocardial protection, despite experimental studies questioning the adequacy of capillary flow to the right ventricle and septum. The capillary distribution of retrograde blood cardioplegia in the human heart is unknown. Hearts from eight transplant recipients with the diagnosis of idiopathic or dilated cardiomyopathy were arrested in situ with cold blood cardioplegia and excised with the coronary sinus intact. Within 20 minutes of explantation, colored microspheres mixed in 37 ° C blood cardioplegia were administered through the coronary sinus at a pressure of 30 to 40 mm Hg for 2 minutes. Twelve transmural myocardial samples were taken horizontally at the level of midventricle and apex to determine regional capillary flow rates. When retrograde warm blood cardioplegia was administered at a rate of 0.42 -+ 0.06 ml/gm/min, the left ventricle, the septum, the posterior wall of the right ventricle, and the apex consistently received capillary flow rates in excess of their metabolic requirements. The capillary perfusion of anterior and lateral walls of the right ventricle was marginally adequate to sustain aerobic metabolism. In explanted human hearts, retrograde blood cardioplegia provides adequate capillary flow to the left ventricle, the septum, the posterior wall of the right ventricle, and the apex; however, capillary flow to the anterior and lateral walls of the right ventricle is marginal. This study delineates the tenuous balance between supply and demand for right ventricular protection with warm continuous retrograde blood cardioplegia. (J TrIORAC CAR-DIOVASC SURG 1995;109:935-40)
Retrograde Coronary Sinus Perfusion for Myocardial Protection during Cardiopulmonary Bypass
Annals of Thoracic Surgery, 1978
The pathophysiology of retrograde coronary sinus perfusion was studied in a vented, nonworking heart in vitro. The fraction of nutritional blood flow, estimated with the trapping index of radioactive microspheres (15 k 5 p), is approximately one-fifth of total flow. The runoff is primarily through the thebesian system and venovenous channels, as is shown with Microfil injection studies. These results suggest that retrograde coronary sinus perfusion would be of marginal value in revascularizing a working heart but would be effective in protecting a hypothermic, nonworking myocardium.