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The Journal of Thoracic and Cardiovascular Surgery, Vol 97, 613-622, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MT Partington, C Acar, GD Buckberg and PL Julia
This study tests the hypothesis that retrograde/antegrade cardioplegic
delivery can overcome the limitations of poor cardioplegic distribution
resulting from either technique alone and, potentially, may expand the
safety of using internal mammary artery grafts in cardiac muscle in
jeopardy of inadequate cardioplegic protection. Jeopardized myocardium was
produced in 20 dogs by ligating the left anterior descending coronary
artery for 15 minutes before starting cardiopulmonary bypass and by 1 hour
of aortic clamping with multidose 6 degrees C cold blood cardioplegia. Five
dogs received antegrade cardioplegia via the aortic root. Ten dogs received
retrograde cardioplegia via the coronary sinus. Five additional dogs
received retrograde/antegrade cardioplegia via both routes. The ligature on
the left anterior descending coronary artery was removed after aortic
unclamping, and regional myocardial temperature (thermistor probe),
segmental shortening (ultrasonic crystals), and global left ventricular and
right ventricular myocardial function were evaluated. Antegrade
cardioplegia produced excellent right ventricular cooling (14 degrees C)
and allowed complete right ventricular functional recovery. However, it
failed to cool muscle supplied by the left anterior descending coronary
artery (only 31 degrees versus 12 degrees C, p less than 0.05),
postischemic global left ventricular function recovered only 38% (p less
than 0.05), and segmental shortening in the region supplied by the left
anterior descending coronary artery recovered only 22% (p less than 0.05).
Retrograde cardioplegia produced homogeneous cooling (17 degrees C) and
allowed near normal recovery of global and regional left ventricular
function (99% and 86%), but right ventricular cooling was variable (19
degrees to 30 degrees C) and right ventricular function recovered
inconstantly (range 64% to 100%, average 82%). The best myocardial
protection occurred after retrograde/antegrade cardioplegia; myocardial
cooling was homogeneous, left ventricular and right ventricular global
function recovered completely (95% and 90%), and regional contractility in
muscle supplied by the left anterior descending coronary artery returned to
84% of control. We conclude that retrograde/antegrade cardioplegia provides
better myocardial protection than either technique alone, ensures good
cardioplegic distribution to the left and right ventricles, and allows
regional delivery of cardioplegic flow to segments supplied by occluded
arteries.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Studies of retrograde cardioplegia. II. Advantages of antegrade/retrograde cardioplegia to optimize distribution in jeopardized myocardium
Division of Thoracic Surgery, University of California Los Angeles Medical Center 90024.
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