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Published on: December 10, 2020
Continuous retrograde blood cardioplegia ensures prolonged aortic cross-clamping time without increasing the
Eric Bezon1, Jean Noël Choplain, Ahmed Abdel Aziz Khalifa
1Department of Cardiovascular and Thoracic Surgery, University Hospital La Cavale Blanche, Brest, France. eric.bezon@chu-brest.fr
Insights
Continuous retrograde blood cardioplegia safely enables prolonged aortic cross-clamping times during complex cardiac procedures. This technique, utilizing lukewarm blood cardioplegia and systemic normothermia, did not increase operative risk in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiothoracic Medicine
Background:
- Prolonged aortic cross-clamping times are often necessary for complex cardiac procedures.
- Ensuring adequate myocardial protection during extended cross-clamping is critical to minimize operative risk.
- Traditional methods may pose challenges for lengthy interventions.
Purpose of the Study:
- To evaluate the safety and efficacy of continuous retrograde blood cardioplegia for extended aortic cross-clamping durations.
- To assess whether this technique increases operative risk, particularly in high-risk patient groups.
- To determine if retrograde cardioplegia facilitates complex cardiac interventions requiring prolonged cross-clamping.
Main Methods:
- Prospective study of 204 patients undergoing cardiac procedures with aortic cross-clamping time >= 150 minutes.
- Inclusion of low, medium, and high-risk groups based on EuroSCORE.
- Myocardial protection involved antegrade hyperkalemic arrest, continuous retrograde lukewarm blood cardioplegia, retrograde reperfusion, and systemic normothermia.
Main Results:
- Mean aortic clamping time was 187+/-45 minutes; mean cardiopulmonary bypass time was 245+/-73 minutes.
- Operative mortality was 8.3%, which was not significantly different from the predicted mortality (8.4%).
- No increase in operative mortality or morbidity was observed despite prolonged cross-clamping times.
Conclusions:
- Continuous retrograde intermediate lukewarm blood cardioplegia, combined with systemic normothermia, is a safe method for myocardial protection during prolonged aortic cross-clamping.
- This technique allows for complex cardiac interventions requiring extended cross-clamping times without elevating operative risk.
- Retrograde cardioplegia offers a viable strategy for managing challenging cardiac surgeries demanding extended cross-clamp durations.
Abstract:
The aim of this study was to assess whether the continuous retrograde blood cardioplegia ensures prolonged aortic cross-clamping time without increasing the operative risk. From 1996 to 2003, 204 consecutive patients who had cardiac procedure requiring aortic cross-clamping time > or = 150 min, were prospectively included in this study: low risk group (EuroSCORE < or = 2) 50 patients, medium risk group (EuroSCORE 3-5) 68 patients, high risk group (EuroSCORE > or = 6) 86 patients. The myocardial protection associated induction of cardiac arrest by antegrade injection of hyperkalemic warm blood, continuous retrograde intermediate lukewarm (20 degrees C) blood cardioplegia, retrograde warm blood reperfusion and systemic normothermia. The mean aortic clamping time was 187+/-45 min (range 150-436 min). The mean cardiopulmonary bypass time was 245+/-73 min (range 168-653 min). The operative mortality was 8.3% (17 patients). The mean predicted mortality of the population studied (EuroSCORE logistic method) was 8.4%+/-12 (range 0.87%-76.15%) with a 95% confidence interval of 6.7% to 10%. The observed mortality was not different from the predicted mortality. Continuous retrograde intermediate lukewarm blood cardioplegia associated with systemic normothermia allows prolonged aortic clamping time for complex intervention without increase of operative mortality and morbidity.
