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Antegrade and retrograde cardioplegia with different reperfusion techniques in patients with multiple coronary artery
V P Kertsman1, S U Kambarov, Y K Mishra
1Bakulev Institute of Cardiovascular Surgery, Moscow, USSR.
Insights
Retrograde cardioplegia and reperfusion offer superior myocardial protection during coronary bypass surgery. This method, particularly with warm oxygenated blood, significantly improves heart function and minimizes structural damage compared to antegrade techniques.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Myocardial Protection
Background:
- Coronary artery bypass grafting (CABG) requires effective myocardial protection.
- Traditional antegrade cardioplegia delivery may have limitations in patients with complex coronary anatomy.
- Optimizing cardioplegic delivery and reperfusion strategies is crucial for patient outcomes.
Purpose of the Study:
- To compare the effectiveness of antegrade versus retrograde cardioplegia and reperfusion techniques.
- To evaluate the impact of different cardioplegic delivery methods on myocardial function and structure.
- To determine the optimal strategy for myocardial protection in patients undergoing CABG.
Main Methods:
- A prospective study of 266 patients undergoing CABG.
- Patients were divided into three groups based on cardioplegic delivery: antegrade only (Group I), antegrade and retrograde cardioplegia with antegrade reperfusion (Group II), and antegrade and retrograde cardioplegia with retrograde reperfusion (Group III).
- Myocardial function was assessed using an online computer model before and after cardiopulmonary bypass; myocardial biopsies were analyzed for ultrastructural changes.
Main Results:
- Group I showed decreased myocardial function post-perfusion.
- Group II demonstrated considerable improvement in myocardial function.
- Group III exhibited further functional improvement and minimal to no ultrastructural myocardial damage, unlike Group I.
- Retrograde reperfusion with warm oxygenated blood in Group III provided maximum myocardial protection.
Conclusions:
- Retrograde cardioplegia and reperfusion, especially with warm oxygenated blood, offer superior myocardial protection in CABG patients.
- This technique is particularly beneficial for patients with multiple coronary artery lesions.
- The findings suggest that optimizing cardioplegic delivery via retrograde routes enhances myocardial preservation and functional recovery.
Abstract:
To evaluate the effectiveness of retrograde cardioplegia and reperfusion, a total of 266 patients undergoing coronary bypass surgery between Nov 1987 to Dec 1989 were divided into three groups depending on the method of cardioplegic fluid delivery and reperfusion. In group I (80 patients) antegrade cardioplegia and reperfusion was used. In group II (98 patients) antegrade and retrograde cardioplegia and antegrade reperfusion was used while in group III antegrade and retrograde cardioplegia and retrograde reperfusion was used. Myocardial functions were studied with the help of an on-line computer on the basis of mathematical model of heart before and after cardiopulmonary bypass. Biopsy specimens were collected before, during and after cardiopulmonary bypass in order to study myocardial structural changes. In group I patients there was decrease in myocardial function in the immediate post perfusion period while group II patients had considerable improvement in their myocardial function and groups III patients showed further improvement in it. Ultrastructural myocardial study revealed considerable detrimental changes in group I, minimal changes in group II and no change in group III patients. Thus in our experience retrograde cardioplegia and retrograde reperfusion with warm oxygenated blood provide maximum myocardial protection in patients with multiple coronary artery lesions.