Related Experiment Videos
[The versatility of anterograde/retrograde cardioplegia in heart surgery]
M S Urrea1, V Herrera, J A Santibáñez
1Departamento de Cirugía Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Insights
Combined antegrade and retrograde coronary sinus (CS) perfusion effectively protects the heart during open-heart surgery. This myocardial protection strategy is safe and can be routinely used in most patients.
Area of Science:
- Cardiovascular Surgery
- Cardiothoracic Medicine
- Surgical Techniques
Context:
- Open-heart surgery requires robust myocardial protection.
- Traditional cardioplegia delivery methods have limitations.
- Evaluating novel perfusion techniques is crucial for improving patient outcomes.
Purpose:
- To assess the efficacy and safety of combined antegrade/retrograde coronary sinus (CS) perfusion for cardioplegia delivery.
- To evaluate the feasibility of CS cannulation via transatrial or direct vision approaches.
- To determine the impact of this technique on myocardial protection and patient mortality.
Summary:
- Eighty patients undergoing open-heart surgery received myocardial protection via combined aortic root (antegrade) and CS (retrograde) perfusion.
- CS cannulation was achieved through transatrial or direct vision methods, with successful infusion in all cases.
- Cooled crystalloid cardioplegia was used, with no reported CS or cardiac vein damage, A-V blockade, or excessive CS pressure (<40 mm Hg).
- Overall hospital mortality was 3.75% (sepsis in 2, stroke in 1).
Impact:
- Combined antegrade/retrograde CS perfusion is a safe and effective method for myocardial protection during open-heart surgery.
- The technique is technically feasible and can be routinely implemented.
- This approach may contribute to reduced perioperative complications and improved surgical outcomes.
Abstract:
Eighty patients underwent open-heart surgery from March 1990 to March 1993. We used combined aortic root (antegrade)/coronary sinus (retrograde) perfusion for cardioplegia delivery as a means of myocardial protection. The special retroplegia cannula was introduced to the coronary sinus (CS) in 67 patients by the transatrial (blind intubation) after one cannula cava insertion; the CS was cannulated under direct vision by right atriotomy after bicaval cannulation in 13 patients. Varied and prolonged cardiac procedures were done using cooled crystalloid cardioplegia (4 centigrades + potassium) except in one patient with severe ventricular damage in whom warm blood cardioplegia was infused. There was no CS or cardiac vein damage or disruption. There was no A-V blockade. The CS was intubated easily in all cases and cardioplegia solution readily infused. Coronary sinus pressure never exceeded 40 mm Hg. Overall hospital mortality (30 days postoperative) was 3.75% (3 cases). Sepsis was the cause of death in 2 patients and stroke in one. Inotropes were used in few cases as a means of renal protection. We conclude that the combined antegrade/retrograde cardioplegia delivery can be used routinely in most patients undergoing open-heart surgery.