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Does simultaneous antegrade and retrograde cardioplegia improve functional recovery and myocardial homeostasis?
M J Jasinski1, S Wos, Z Kadziola
1Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, United Kingdom. marek.jasinski@glenfield-tr.trent.nhs.uk
Insights
Simultaneous antegrade and retrograde cardioplegia better preserves myocardial oxygen utilization and functional recovery compared to retrograde alone. Anaerobic metabolism markers showed no significant difference between the two methods.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Myocardial Protection
Background:
- Myocardial preservation is critical during cardiac surgery.
- Different cardioplegia techniques aim to optimize myocardial protection.
Purpose of the Study:
- To compare functional recovery and homeostasis of the myocardium.
- Evaluate simultaneous continuous antegrade and retrograde cardioplegia versus continuous retrograde cardioplegia.
Main Methods:
- Prospective study of 40 patients undergoing coronary artery bypass grafting (CABG).
- Two groups: continuous retrograde cardioplegia (n=24) and simultaneous antegrade/retrograde cardioplegia (n=16).
- Measured myocardial oxygen utilization, anaerobic metabolism markers, and cardiac function parameters.
Main Results:
- Simultaneous cardioplegia showed better recovery of myocardial oxygen content and extraction post-cross-clamping.
- No significant differences in hydrogen ion, carbon dioxide, or lactate release between groups.
- A trend towards better left ventricle stroke work index recovery was observed in the simultaneous group.
Conclusions:
- Simultaneous antegrade and retrograde cardioplegia appears advantageous for preserving myocardial viability and function.
- No difference in anaerobic metabolism markers suggests similar protection against anaerobic damage.
- This technique may offer superior myocardial protection over retrograde cardioplegia alone.
Background:
The purpose of our research was to evaluate the functional recovery and homeostasis of myocardium during simultaneous continuous retrograde and antegrade cardioplegia versus continuous retrograde cardioplegia.
Methods:
Forty patients who underwent elective coronary artery bypass grafting (CABG) were prospectively assigned to two clinically matched groups and analyzed in respect to cardioplegia protocol. Group I consisted of 24 patients who received continuous retrograde blood cardioplegia; Group II consisted of 16 patients who received simultaneous continuous ante- and retrograde cardioplegia. Hydrogen ion release, carbon dioxide, lactate concentration oxygen content, and oxygen extraction were measured from coronary sinus effluent and from the arterial line before and after cross-clamping of the aorta. Median changes of these parameters were reported. Cardiac output was measured and left and right ventricle stroke works were calculated. Incidence of low cardiac output, ventricular fibrillation, raised cardiac enzymes, and ischemic changes on electrocardiogram (ECG) were noted.
Results:
In the simultaneous group, oxygen content and oxygen extraction recovered well after cross-clamping. The same parameters did not recover to the same extent in the retrograde group. These changes were notable between groups. Hydrogen ion, carbon dioxide, and lactate releases were comparable between groups. Trend toward better recovery of left ventricle stroke work index was encountered in the simultaneous group.
Conclusions:
Viability of myocardium measured with oxygen utilization and functional recovery is better preserved with simultaneous antegrade and retrograde cardioplegia. However, there is no difference in anaerobic metabolism markers. Thus simultaneous ante- and retrograde cardioplegia is probably advantageous over retrograde alone.