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A technique for infusion of cardioplegic solution in coronary artery bypass with aortic regurgitation
Mizuho Imamaki1, Tadayuki Shimakura
1Department of Cardiovascular Surgery, Fukuyama Cardiovascular Hospital, Fukuyama, Japan. imamaki-cuh@umin.ac.jp
Insights
A novel cardioplegia delivery technique for on-pump coronary artery bypass surgery in patients with aortic regurgitation ensures rapid cardiac arrest and avoids heart failure complications. This method offers a viable alternative when other techniques are not feasible.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
Background:
- On-pump coronary artery bypass (CAB) surgery with mild-to-moderate aortic regurgitation (AR) poses risks of heart failure due to inadequate cardioplegia.
- A modified cardioplegia administration technique was developed to mitigate these risks.
Observation:
- During cardiopulmonary bypass and aortic cross-clamping, cardioplegic solution was initially administered from the aortic root.
- As rapid cardiac arrest was not achieved, the aortic root was incised, and the aortic valve cusps were temporarily sutured.
- Following aorta closure and subsequent cardioplegia administration from the aortic root, rapid cardiac arrest was achieved.
Findings:
- The temporary suturing of aortic valve cusps facilitated effective cardioplegia delivery and rapid cardiac arrest.
- Post-procedure, there was no observed exacerbation of aortic regurgitation compared to the preoperative state.
Implications:
- This technique provides an alternative method for cardioplegia delivery in complex CAB cases.
- It is particularly useful when off-pump CAB is not possible or retrograde cardioplegia is contraindicated.
Background:
Complications such as heart failure due to insufficient cardioplegia may develop in on-pump coronary artery bypass (CAB) with mild-to-moderate aortic regurgitation (AR). A technique for administration of cardioplegic solution was carried out to avoid such complications.
Methods And Results:
Cardiopulmonary bypass was established. After aortic cross-clamping, cardioplegic solution was administered from aortic root. Because complete cardiac arrest was not rapidly achieved, the aortic root was incised. Three cusps of the aortic valve were sutured. The aorta was closed; cardioplegic solution was administered from the aortic root. Then, cardiac arrest was rapidly achieved. After distal anastomosis of quadruple bypass was completed, the suture of the cusps was removed. There was no exacerbation of AR due to this method compared to the preoperative state.
Conclusion:
When off-pump coronary artery bypass is impossible and retrograde cardioplegia cannot be performed for a certain reason, this method may be set to one of the choices.
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