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[Clinical study on the use of retrograde cardioplegia with St. Thomas' Hospital solution]
T Sakurada1, R Kuribayashi, S Sekine
1Department of Cardiovascular Surgery, Akita University School of Medicine.
Insights
Retrograde cardioplegia using St. Thomas
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiomyocyte Protection
Context:
- Open heart operations for aortic valve disease and ischemic heart disease require effective myocardial protection.
- Traditional antegrade cardioplegia may have limitations in certain patient populations or surgical scenarios.
- Retrograde cardioplegia offers an alternative delivery route for myocardial protection agents.
Purpose:
- To evaluate the efficacy and safety of retrograde cardioplegia using cold St. Thomas' Hospital solution for myocardial protection during open heart operations.
- To assess cardiac recovery, hemodynamic stability, and postoperative outcomes in patients undergoing aortic valve surgery or coronary revascularization.
Summary:
- One hundred and three patients with aortic valve disease and twenty-seven with ischemic heart disease underwent open heart surgery utilizing retrograde cardioplegia via a coronary sinus catheter.
- Cold St. Thomas' Hospital solution was administered via drip method with topical saline slush.
- Excellent cardiac resuscitation and acceptable hemodynamics were achieved in all patients, with good myocardial protection evidenced by postoperative data and enzymatic analyses (CK-MB).
Impact:
- Retrograde cardioplegia with St. Thomas' Hospital solution is demonstrated as an effective and safe alternative for myocardial protection in complex cardiac surgeries.
- This technique facilitates easy cardiac resuscitation and promotes favorable postoperative hemodynamics, even with extended aortic cross-clamping times.
- The findings support the broader application of retrograde cardioplegia in aortic valve and coronary revascularization procedures.
Abstract:
One hundred and three consecutive patients with aortic valve disease and twenty seven patients with ischemic heart disease of severe critical coronary stenosis or left main trunk stenosis underwent open heart operations with the use of retrograde cardioplegic technique for myocardial protection. Under complete cardiopulmonary bypass, a balloon catheter was inserted into the coronary sinus through small right atriotomy and secured in place. Retrograde cardioplegia was accomplished using cold St. Thomas' Hospital solution by drip method at height of 60 to 80 cm with topical saline slush. Cardiac resuscitation was very easy and acceptable hemodynamics were obtained in all patients. Even in 8 patients in which aortic crossclamping time was above 180 minutes cardiac recovery was excellent except one who needed IABP support. Eight patients in aortotomy group were died postoperatively from the reasons unrelated to myocardial protection. Postoperative hemodynamic data and enzymatic analyses of CK-MB revealed good myocardial protective effects. Retrograde cardioplegia with the use of cold St. Thomas' Hospital solution is thus an effective alternative of myocardial protection in aortic valve surgery or aortotomy surgery and in coronary revascularization for multiple coronary stenoses or left main trunk lesions.