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Evaluation of the effects of different cardioplegic techniques on left ventricular function during coronary artery
Y Nakashima1, W Maldarelli, Y Oka
1Department of Anesthesiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10461.
Insights
Intermittent cold cardioplegia methods show no significant global left ventricular function changes post-CABG surgery. However, regional wall motion abnormalities indicate incomplete myocardial protection, especially in the right coronary artery territory.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiothoracic Anesthesia
Background:
- Coronary artery bypass grafting (CABG) requires effective myocardial protection.
- Intermittent cold cardioplegia strategies aim to preserve left ventricular function during surgery.
- Evaluating regional myocardial function is crucial for assessing protection efficacy.
Purpose of the Study:
- To compare the effects of intermittent anterograde cold cardioplegia (IACCH) and intermittent combined anterograde-retrograde cold cardioplegia (IRCCN) on left ventricular function post-CABG.
- To identify specific patterns of regional myocardial dysfunction associated with each cardioplegia technique.
Main Methods:
- Prospective study of 50 consecutive patients undergoing CABG.
- Transesophageal echocardiography (TEE) used to assess global and regional left ventricular function.
- Comparison of IACCH versus IRCCN in terms of inotrope requirements and regional wall motion abnormalities.
Main Results:
- No significant change in global left ventricular function was observed in either group.
- Increased inotrope requirement was noted in the IACCH group.
- Regional wall motion abnormalities indicative of myocardial ischemia were detected in both groups, with specific patterns related to coronary artery territories (Right Coronary Artery: IACCH 20%, IRCCN 16%; Left Circumflex Artery: IACCH 12%; Left Anterior Descending Artery: IRCCN 12%).
Conclusions:
- While global left ventricular function remains stable, regional wall motion analysis reveals incomplete myocardial protection with both IACCH and IRCCN.
- The vulnerability of the right coronary artery territory necessitates targeted strategies for enhanced myocardial protection.
- Differences in protection characteristics highlight the need for method-specific adjustments in cardioplegia delivery.
Abstract:
Fifty consecutive patients undergoing coronary artery bypass grafting surgery were studied to evaluate the effect of intermittent anterograde cold cardioplegia (IACCH) and intermittent combined anterograde-retrograde cold cardioplegia (IRCCN) on left ventricular function using transesophageal echocardiography. Global function did not significantly change in both groups, but significantly more inotropes were required in IACCH. Newly developed abnormalities of regional wall motion after cardiopulmonary bypass, which were indicative of ischemic myocardium, were detected in the segments supplied by the right coronary artery in both groups (IACCH, 20%; IRCCN, 16%), by the left circumflex coronary artery only in IACCH (12%) and by the left anterior descending coronary artery only in IRCCN (12%). It is concluded that although global evaluation of left ventricular function did not show any significant change after IACCH and IRCCN under routine management, analysis of abnormalities of regional wall motion provided specific information. In both groups, complete protection of the myocardium was not achieved, and the characteristics of poorly protected areas were dependent on the difference in the two methods. Myocardium supplied by the right coronary artery seemed to be particularly vulnerable, and a special effort to protect these segments is mandatory for a successful outcome.