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Comparison of retrograde vs simultaneous ante/retrograde cold blood cardioplegia
M Jasinski1, S Wos, Z Kadziola
12nd Department of Cardiac Surgery, Silesian Medical Academy, Katowice, Poland.
Insights
Simultaneous antegrade and retrograde cardioplegia better preserves myocardial metabolic viability and oxygen utilization compared to retrograde-only methods. This approach aids in faster recovery of myocardium homeostasis after cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Myocardial Protection
Background:
- Myocardial protection is crucial during cardiac surgery.
- Evaluating cardioplegia delivery methods is essential for optimizing outcomes.
- Continuous cardioplegia strategies aim to maintain myocardial homeostasis.
Purpose of the Study:
- To compare myocardial homeostasis during simultaneous antegrade and retrograde cardioplegia versus retrograde continuous cardioplegia.
- To assess the impact of different cardioplegia delivery methods on myocardial metabolic recovery.
Main Methods:
- 40 patients undergoing coronary artery bypass grafting were randomized into two groups.
- Group 1 received retrograde continuous blood cardioplegia (n=24).
- Group 2 received simultaneous antegrade/retrograde cardioplegia (n=16).
- Metabolic parameters (acidosis, oxygen content, extraction, consumption) were measured from coronary sinus and arterial lines before and after cross-clamping.
- Incidence of low cardiac output, ventricular fibrillation, elevated cardiac enzymes, and ECG ischemic changes were recorded.
Main Results:
- The simultaneous antegrade/retrograde group showed significant recovery in myocardial oxygen consumption and other metabolic parameters post-reperfusion.
- Parameters in the retrograde-only group did not recover significantly, with notable differences in oxygen extraction and consumption (p<0.05).
- Significant intergroup differences were observed in metabolic recovery, indicating superior myocardial protection with the combined approach.
Conclusions:
- Simultaneous antegrade and retrograde cardioplegia demonstrates superior preservation of myocardial metabolic viability.
- Oxygen utilization by the myocardium is better maintained with the combined delivery method.
- This strategy may lead to improved cardiac function and reduced ischemia-related complications post-cardiac surgery.
Background:
To evaluate the homeostasis of myocardium during simultaneous continuous retrograde and antegrade cardioplegia vs retrograde continuous cardioplegia.
Methods:
40 patients who underwent elective operation of coronary arteries bypass grafting were randomly assigned to 2 groups: group one consisted of 24 patients who received retrograde continuous blood cardioplegia; group two consisted of 16 patients who received simultaneous continuous ante/retrograde cardioplegia. The following measurements were taken: acidosis, oxygen content, oxygen extraction and oxygen consumption; they were taken before and after cross-clamp releasing from coronary sinus effluent and from arterial line. Incidence of low cardiac output, ventricular fibrillation, raised cardiac enzymes and ischemic changes on ECG was noted.
Results:
In simultaneous group such parameters as acidosis, oxygen content, oxygen extraction and myocardial oxygen consumption recovered after cross-clamping and changes of their values were respectively: 0.0005, 0.87 ml/100 ml, 0.098 and 1.4 ml/min. The same parameters didn't recovered in retrograde group and changes were respectively: 0.05 - p=0.2; 3.7 ml/100 ml - p=0.006, 0.29 p=0.006 and 7.4 ml/min - p=0.03. These changes were significant between groups.
Conclusions:
Metabolic viability of myocardium measured with oxygen utilisation is better preserved with simultaneous antegrade and retrograde cardioplegia.