Coronary Perfusion Pressure during Antegrade Cardioplegia in On-Pump CABG Patients

Abstract

ObjectiveThe aim of this study was to investigate whether aortic tension estimated by palpation and cardioplegia infusion line pressure provide results equivalent to those obtained with direct aortic intraluminal pressure measurement.MethodsSixty consecutive patients who underwent coronary artery bypass graft surgeries with extracorporeal circulation were analyzed. Sanguineous cardioplegic solution in a ratio of 4:1 was administered using a triple lumen antegrade cannula. After crossclamping, cardioplegia was infused and aortic root pressure was recorded by surgeon (A) considering the aortic tension he felt in his fingertips. At the same time, another surgeon (B) recorded his results for the same measurement. Concomitantly, the anesthesiologist recorded intraluminal pressure in the aortic root and the perfusionist recorded delta pressure in cardioplegia infusion line. None of the participants involved in these measurements was allowed to be informed about the values provided by the other examiners.ResultsThe Bland-Altman test showed that a considerable variation between aortic wall tension was found as measured by palpation and by intraluminal pressure, with a bias of -9.911±18.75% (95% limits of agreement: -46.7 to 26.9). No strong correlation was observed between intraluminal pressure and cardioplegia line pressure (Spearman's r=0.61, 95% confidence interval 0.5-0.7; P<0.0001).ConclusionThese findings reinforce that cardioplegia infusion should be controlled by measuring intraluminal pressure, and that palpation and cardioplegia line pressure are inaccurate methods, the latter should always be used to complement intraluminal measurement to ensure greater safety in handling the cardioplegia circuit.

Myocardial protection in cardiac surgery: how limited are the options? A comprehensive literature review

“…19 Cardioplegia line pressure should be measured to investigate possible obstructions during infusion to prevent accidents such as circuit rupture and avoid high pressures usually associated with haemolysis. 20 Direct intravascular measurement is the most reliable method to determine aortic pressure during cardioplegic infusion and to ensure effectiveness and safety. 21 A double lumen catheter allows for simultaneous administration of antegrade cardioplegia and aortic root pressure assessment, though care should be taken to minimise the effects of interfering variables such as flow velocity, viscosity and temperature of the infused solution.…”

“…21 A double lumen catheter allows for simultaneous administration of antegrade cardioplegia and aortic root pressure assessment, though care should be taken to minimise the effects of interfering variables such as flow velocity, viscosity and temperature of the infused solution. 20,21 The precise optimal pressure for antegrade cardioplegia delivery is poorly described, but is assumed to be in the range between normal diastolic and normal mean blood pressure. 21 During retrograde delivery of solutions, coronary sinus pressure may be assessed because of its fragility and possibility of rupture.…”

Potassium and Cardiac Surgery

“…Anterograde cardioplegia refers to delivering cardioplegic solution through a cannula inserted just proximal to the aortic cross-clamp. From there, the solution can flow into the left and right coronary arteries that supply the myocardium [32]. With anterograde cardioplegia, arrest usually occurs within 30 to 60 seconds.…”

“…severe stenosis) or aortic valve damage. Unlike Potassium and Cardiac Surgery DOI: http://dx.doi.org/10.5772/intechopen.99735 anterograde administration, in retrograde administration the cardioplegia catheter is inserted into the coronary sinus from the right atrium, and solution is injected at a lower pressure (given the lower tolerance of the coronary sinus walls to turbulent flow) to avoid coronary sinus perforation [32].…”

Thoracic Organ Procurement during Multi-Organ Retrieval

“…We suggest a dual lumen cardioplegia cannula and transduce the pressure line to monitor the aortic root pressure of the patient. This helps us by telling us the cardioplegia perfusion pressure (ideal is 60-80 mmHg) [10].…”