Aortic valve replacement. Aortic root versus coronary sinus perfusion with blood cardioplegic solution

Area of Science:

• Cardiology
• Cardiac Surgery
• Cardiothoracic Anesthesia

Background:

• The efficacy of retrograde coronary sinus cardioplegia for myocardial protection during aortic valve replacement (AVR) remains under investigation.
• Optimal methods for myocardial preservation during AVR, especially when combined with coronary artery bypass grafting, are crucial.

Purpose of the Study:

• To compare the safety and efficacy of retrograde coronary sinus cardioplegia versus traditional aortic root cardioplegia in patients undergoing elective AVR.
• To evaluate myocardial preservation and ventricular function post-procedure.

Main Methods:

• A prospective study involving 63 patients undergoing elective AVR.
• Patients received cold potassium blood cardioplegia via either aortic root (n=36) or coronary sinus (n=27).
• Key parameters including septal temperature, cardiac enzyme release, and ventricular function were assessed.

Main Results:

• The retrograde group showed a trend towards lower mean septal temperatures and reduced myocardial-specific isoenzyme release.
• Both methods demonstrated equal preservation of right and left ventricular function.
• Volume-loading studies indicated potentially improved diastolic performance with retrograde cardioplegia.

Conclusions:

• Retrograde coronary sinus cardioplegia is a safe and effective alternative to aortic root cardioplegia for myocardial preservation in elective AVR.
• The technique provides comparable clinical outcomes and ventricular function to the standard method.