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J Thorac Cardiovasc Surg 1998;115:716-722
© 1998 Mosby, Inc.

CARDIOPULMONARY SUPPORT AND PHYSIOLOGY

Simultaneous Antegrade And Retrograde Delivery Of Continuous Warm Blood Cardioplegia After Global Ischemia

This study was supported by grants from the Swedish Heart LungFoundation, from the Swedish Medical Research Council (grant no.11235), the Karolinska Institute, and from the Karolinska Hospital.

Received for publication Feb. 25, 1997; revisions requested May 7, 1997; revisions received Sept. 22, 1997; accepted for publication Sept. 22, 1997. Address for reprints: Anders B. Ericsson, MD, Department ofThoracic Surgery, Karolinska Hospital, S-171 76, Stockholm, Sweden.

Abstract

Objective: Simultaneous delivery of antegrade and retrograde cardioplegia may provide a more homogeneous distribution of cardioplegic solution. It may, however, increase myocardial edema and postcardioplegic myocardial injury. The purpose of this study was to compare simultaneous antegrade-retrograde cardioplegia with antegrade cardioplegia.
Methods: After 30 minutes of warm, "unprotected," global ischemia, pigs were given warm, continuous blood cardioplegia for 45 minutes (antegrade group, n  = 8 and simultaneous antegrade-retrograde group, n = 9). All pigs were weaned from cardiopulmonary bypass 45 to 60 minutes after aortic unclamping. Indices of left ventricular function were measured after another 30 minutes with the conductance catheter technique and pressure-volume loops.
Results: Global left ventricular function, evaluated by preload recruitable stroke work, decreased from baseline values of 126 (102 to 150) (mean [90% confidence limits]) (antegrade) and 122 (116 to 127) erg/ml x 10³ (simultaneous) to 75 (61 to 89) (p = 0.004) and 95 (79 to 112) erg/ml x 10³ (p = 0.02), respectively. End-diastolic pressure-volume relation increased from 0.25 (0.21 to 0.28) (antegrade) and 0.30 (0.25 to 0.35) mm Hg/ml (simultaneous) to 0.60 (0.41 to 0.79) (p = 0.009) and 0.53 (0.35 to 0.71) mm Hg/ml (p = 0.02), respectively. The time constant of left ventricular pressure relaxation was unchanged. No intergroup difference was observed in preload recruitable stroke work, preload recruitable stroke work area, end-diastolic pressure volume relation, or stiffness constant. Plasma levels of troponin T increased without any difference between groups. Myocardial water content was increased in the simultaneous group (81.1% [80.7% to 81.5%]) versus the antegrade group (80.1% [79.6% to 80.7%], p = 0.01).
Conclusion: Despite a small increase in myocardial water content induced by simultaneous blood cardioplegia, no impairment of postcardioplegic cardiac function was observed compared with antegrade cardioplegia.

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