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Efficacy of retrograde coronary sinus cardioplegia in patients undergoing myocardial revascularization: a prospective
J T Diehl1, E J Eichhorn, M A Konstam
1Department of Cardiothoracic Surgery, New England Medical Center Hospital, Boston, MA 02111.
Insights
Retrograde coronary sinus cardioplegia (RCSC) offers comparable myocardial protection to aortic root cardioplegia (ARC) during coronary artery bypass grafting (CABG). RCSC demonstrated improved postoperative left ventricular ejection fraction in CABG patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Physiology
Background:
- Aortic root cardioplegia (ARC) is standard for myocardial protection during coronary artery bypass grafting (CABG).
- The efficacy of retrograde coronary sinus cardioplegia (RCSC) compared to ARC has not been critically evaluated in CABG patients.
Purpose of the Study:
- To compare the efficacy of RCSC versus ARC for intraoperative myocardial protection and postoperative ventricular function in patients undergoing elective CABG.
Main Methods:
- Twenty patients undergoing elective CABG were prospectively randomized into two groups: Group I (10 patients) received cold blood ARC, and Group II (10 patients) received cold blood RCSC.
- Ventricular function was assessed preoperatively and postoperatively using radionuclide ventriculography and hemodynamic studies with volume loading.
Main Results:
- Both groups had similar demographics and postoperative ventricular function (stroke work index vs. EDVI for both ventricles).
- Left ventricular ejection fraction (LVEF) showed no significant change in the ARC group (50% to 53%) but improved significantly in the RCSC group (49% to 60%, p < 0.05).
- Postoperative left ventricular systolic and diastolic functions were similar between the two groups.
Conclusions:
- Retrograde coronary sinus cardioplegia (RCSC) provides effective intraoperative myocardial protection during CABG.
- RCSC demonstrates excellent postoperative ventricular function, comparable to aortic root cardioplegia (ARC), in patients undergoing elective CABG.
Abstract:
The efficacy of retrograde coronary sinus cardioplegia (RCSC) administered through the right atrium compared with aortic root cardioplegia (ARC) has not been examined critically in patients undergoing coronary artery bypass grafting (CABG). Twenty patients having elective CABG were randomized prospectively to receive cold blood ARC (Group I, 10 patients) or cold blood RCSC (Group II, 10 patients). Patient demographics were similar in both groups. Ventricular function was assessed preoperatively by radionuclide ventriculography and postoperatively by simultaneous hemodynamic and radionuclide ventriculographic studies with volume loading. There was no change in ejection fraction (EF) (preoperative versus postoperative value) in Group I (50 +/- 6% versus 53 +/- 6%) but in group II, at similar peak systolic pressure and similar left ventricular end-diastolic volume index (LVEDVI), LVEF improved significantly (49 +/- 6% versus 60 +/- 12%, p less than 0.05). Postoperative ventricular function (stroke work index versus EDVI) for the left ventricle and right ventricle were similar in both groups. Evaluation of postoperative LV systolic function (end-systolic blood pressure versus end-systolic volume index) and diastolic function (pulmonary capillary wedge pressure versus EDVI) were also similar in both groups. Retrograde coronary sinus cardioplegia is as effective as ARC for intraoperative myocardial protection, and provides excellent postoperative function in patients undergoing elective CABG.