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[Comparison between antegrade and retrograde cardioplegia with warm blood]
N Yamamoto1, K Hisamochi, T Morimoto
1Department of Surgery II, Okayama University of Medical School, Japan.
Insights
Antegrade infusion of continuous warm blood cardioplegia (BCP) better maintains aerobic metabolism and cardiac function post-surgery compared to retrograde infusion. This method also reduced ventricular fibrillation incidence, indicating superior myocardial protection.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Continuous warm blood cardioplegia (BCP) is a promising myocardial protection strategy.
- The optimal delivery method (antegrade vs. retrograde) for BCP remains unclear.
Purpose of the Study:
- To compare the efficacy of antegrade and retrograde continuous warm BCP.
- To evaluate effects on myocardial metabolism, oxygen extraction, enzyme release, cardiac function, and edema.
Main Methods:
- Fourteen dogs underwent cardiopulmonary bypass and aortic cross-clamping (120 min) followed by reperfusion (60 min).
- Dogs were divided into antegrade (Group A) and retrograde (Group R) continuous warm BCP groups.
- Metabolic markers, oxygen extraction, serum enzymes, cardiac function, and edema were assessed.
Main Results:
- Antegrade BCP maintained aerobic metabolism (excess lactate, redox potential, lactate extraction), unlike retrograde BCP.
- Myocardial oxygen extraction ratio was significantly higher in Group A post-reperfusion.
- Ventricular fibrillation incidence was significantly lower in Group A (1/7) versus Group R (7/7).
Conclusions:
- Antegrade continuous warm blood cardioplegia provides superior myocardial protection compared to retrograde infusion.
- Antegrade BCP better preserves aerobic metabolism and cardiac function, reducing arrhythmias post-reperfusion.
Abstract:
Recently continuous warm blood cardioplegia (BCP) has been reported as a superior method of myocardial protection, but it is unknown which is more effective antegrade or retrograde cardioplegia. This study was performed to investigate the efficacy of antegrade infusion via aortic root and retrograde infusion via coronary sinus with continuous warm BCP in regard to metabolism, oxygen extraction ratio, serum enzyme release, cardiac function, and myocardial edema. Fourteen adult mongrel dogs were subjected to total cardiopulmonary bypass and cross-clamp of the aorta for 120 minutes, and followed by 60 minutes reperfusion. The dogs were divided into two groups according to the infusion type of continuous warm blood cardioplegia: Group A, antegrade warm BCP, and Group R, retrograde warm BCP. Changes in excess lactate (delta XL), redox potential (delta Eh), and myocardial lactate extraction ratio showed that aerobic metabolism could be maintained in group A and could not in group R. Myocardial oxygen extraction ratio during aortic cross-clamp was same in group A and in group R, but at 5 minutes after reperfusion it was significantly higher in group A than in group R (41 +/- 8% V.S. 22 +/- 9%). The incidence of ventricular fibrillation (V.F.) after reperfusion was significantly lower in group A than in group R (1/7 V.S. 7/7). CPK-MB and HBDH releases during aortic cross-clamp and 60 minutes reperfusion were lower in group A than in group R, but not significant. Generations of lipid peroxides (A-Cs difference) were lower in group R than in group A, but not significant.(ABSTRACT TRUNCATED AT 250 WORDS)