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Retrograde cardioplegia infusion during coronary bypass surgery. Early clinical experience
N Shapira1, P E Turner, D Morse
1Section of Cardiovascular Surgery, Medical Center of Delaware, Christiana Hospital, Newark.
Insights
Coronary sinus infusion of cardioplegia effectively protects the heart muscle during surgery for severe coronary artery disease (CAD). This method ensures adequate myocardial protection, even in complex cases, preventing adverse cardiac events.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiothoracic Medicine
Background:
- Aortic root cardioplegia infusion is standard but may be insufficient for patients with critical coronary artery disease (CAD).
- Severe CAD poses challenges for myocardial protection during cardiac surgery.
Purpose of the Study:
- To evaluate the efficacy of coronary sinus (CS) route for cardioplegia infusion in patients with severe CAD.
- To assess myocardial protection and preservation of cardiac function using the CS route.
Main Methods:
- Blood cardioplegia infused via CS using a Foley catheter in 19 consecutive patients with severe CAD.
- Monitored CS pressure at 30 mmHg, with an average ischemic time of 83 minutes and 4.9 bypasses.
- Hemodynamic parameters, myocardial temperature, and clinical outcomes were assessed.
Main Results:
- Good preservation of myocardial function observed, with stable cardiac index and unchanged pulmonary capillary wedge pressure.
- Systemic vascular resistance decreased by 30% without significant changes in blood pressure.
- No deaths and only one perioperative myocardial infarction reported, with homogeneous myocardial cooling.
Conclusions:
- Coronary sinus cardioplegia infusion is a safe and effective method for myocardial protection in patients with critical and extensive coronary artery disease.
- This technique ensures adequate cardiac function preservation, even in high-risk surgical candidates.
- CS infusion offers a viable alternative for myocardial protection when aortic root delivery is suboptimal.
Abstract:
Although aortic root cardioplegia infusion has been generally satisfactory, adequate myocardial protection in patients with critical coronary artery disease (CAD) cannot always be achieved by this route. We report our experience with our first 19 consecutive patients, all with exceptionally severe disease in whom the coronary sinus route was utilized for cardioplegia infusion. Eleven had unstable angina, and three had persistent chest pain requiring intensive antianginal therapy right up to time of surgery. Blood cardioplegia was infused via the coronary sinus using a Foley Catheter under a monitored pressure of 30 mmHg. Ischemic time was 83 +/- 27 minutes. Number of vessels bypassed was 4.9 +/- 0.9. Prebypass hemodynamic profile was compared to the profile at 15 and 75 minutes, and at 6, 12 and 24 hours after cessation of bypass, and revealed good preservation of myocardial function: Cardiac index, stroke volume index and pulmonary capillary wedge pressure remained unchanged, systemic vascular resistance decreased by 30%, while changes of lesser magnitude were observed in systemic and pulmonary blood pressure. There was no death and one perioperative myocardial infarction. Myocardial temperature was monitored by needle thermisters and demonstrated homogeneous myocardial cooling in spite of the severity of CAD. Thus, preservation of cardiac function even in patients with critical and extensive CAD can be achieved by coronary sinus infusion of cardioplegia.