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Retrograde coronary perfusion: effects on iatrogenic edema and diastolic properties
D A Dean1, C X Jia, S E Cabreriza
1Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA.
Insights
Retrograde cardioplegia infusion in porcine hearts resulted in less heart weight gain and myocardial water content increase compared to antegrade infusion. This suggests retrograde flow may better preserve diastolic function.
Area of Science:
- Cardiovascular Surgery
- Cardiothoracic Research
- Myocardial Preservation
Background:
- The optimal method for delivering cardioplegic solutions, antegrade versus retrograde infusion, remains unclear regarding effects on myocardial properties.
- Understanding these differences is crucial for improving cardiac surgical outcomes.
Purpose of the Study:
- To compare the effects of antegrade and retrograde cardioplegic solution infusion on heart weight, myocardial water content, and diastolic function.
- To evaluate hemodiluted blood flow in isolated, hypothermic porcine hearts.
Main Methods:
- Isolated porcine hearts underwent cardiectomy and perfusion with hemodiluted blood (100% lactated Ringer's to 50% blood).
- Infusion was either antegrade (n=6) or retrograde (n=6) at controlled pressures.
- Measurements included heart weight, myocardial water content, and left ventricular pressure-volume relationships pre- and post-perfusion.
Main Results:
- Antegrade infusion led to significantly greater increases in heart weight (36 +/- 4 g) and myocardial water content (6.9% +/- 1.0%) compared to retrograde infusion (5 +/- 2 g and 2.5% +/- 0.4%, respectively).
- Ventricular filling, assessed by left ventricular volume at specific pressures, was also greater with antegrade flow.
Conclusions:
- Retrograde cardioplegic infusion in isolated porcine hearts demonstrated reduced changes in heart weight and myocardial water content.
- Retrograde flow was associated with preserved diastolic properties, unlike antegrade infusion.
Background:
The relative merits of antegrade infusion and retrograde infusion of cardioplegic solution in terms of heart weight, myocardial water content, and ventricular diastolic properties are undefined. Accordingly, we compared antegrade and retrograde flow of hemodiluted blood in isolated, hypothermic porcine hearts.
Methods:
After cardiectomy, 1 L of cold heparinized blood diluted with lactated Ringer's solution to concentrations ranging from 100% lactated Ringer's to 50% lactated Ringer's and 50% blood was perfused in an antegrade (n = 6) or retrograde (n = 6) fashion at mean pressures of 62 +/- 2 mm Hg (+/- standard error of the mean) and 49 +/- 2 mm Hg, respectively. Heart weight, myocardial water content, and left ventricular pressure-volume relationships were obtained before and after perfusion.
Results:
In the comparison of measurements before and after perfusion, changes in heart weight (36 +/- 4 g versus 5 +/- 2 g; p < 0.05), myocardial water content (6.9% +/- 1.0% versus 2.5% +/- 0.4%; p < 0.01), and ventricular filling measured by normalized left ventricular volume at 10, 15, and 20 mm Hg were greater in the antegrade group.
Conclusions:
In the isolated porcine heart, retrograde flow is distinguished from antegrade flow by less change in heart weight and myocardial water content and no diastolic dysfunction.