Continuous retrograde blood cardioplegia is associated with lower hospital mortality after heart valve surgery

Flameng, Willem; Herijgers, Paul; Dewilde, Sarah; Lesaffre, Emmanuel

doi:10.1067/mtc.2003.77

Cited by 11 publications

(2 citation statements)

References 20 publications

(11 reference statements)

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“…Retrograde perfusion through the coronary sinus avoids the possibility of aortic insufficiency and is used routinely for cardioplegia delivery during cardiac surgery 9,10 but its use for machine perfusion of donor hearts is rudimentary at best. 11 Furthermore, we previously reported that right ventricular perfusion was reduced in canines when using retrograde perfusion, illustrating a potential limitation of this technique.…”

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confidence: 99%

Metabolic characteristics of human hearts preserved for 12 hours by static storage, antegrade perfusion, or retrograde coronary sinus perfusion

Cobert¹,

Merritt²,

West³

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Objective(s) Machine perfusion of donor hearts is a promising strategy to increase the donor pool. Antegrade perfusion is effective but can lead to aortic valve incompetence and non-nutrient flow. Experience with retrograde coronary sinus perfusion of donor hearts has been limited. We tested the hypothesis that retrograde perfusion could support myocardial metabolism over an extended donor ischemic interval. Methods Human hearts from donors rejected or not offered for transplantation were preserved for 12 hours in University of Wisconsin Machine Perfusion Solution by: 1. Static hypothermic storage 2. Hypothermic antegrade machine perfusion or 3. Hypothermic retrograde machine perfusion. Myocardial oxygen consumption (MVO2), and lactate accumulation were measured. Ventricular tissue was collected for proton (1H) and phosphorus-31 (31P) magnetic resonance spectroscopy (MRS) to evaluate the metabolic state of the myocardium. Myocardial water content was determined at end-experiment. Results Stable perfusion parameters were maintained throughout the perfusion period with both perfusion techniques. Lactate/alanine ratios were lower in perfused hearts compared to static hearts (p<.001). Lactate accumulation (Antegrade 2.0±.7, Retrograde 1.7±.1 mM) and MVO2 (Antegrade 0.25±.2, Retrograde 0.26±.3 mL O2/min/100g) were similar in machine perfused groups. High energy phosphates were better preserved in both perfused groups (p<.05). Left ventricular myocardial water content was increased in retrograde perfused (80.2±.8%) compared to both antegrade perfused (76.6±.8%, p=.02) and static storage hearts (76.7±1%, p=.02). Conclusions In conclusion, machine perfusion by either the antegrade or the retrograde technique can support myocardial metabolism over long intervals. Machine perfusion appears promising for long term preservation of human donor hearts.

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confidence: 99%

Metabolic characteristics of human hearts preserved for 12 hours by static storage, antegrade perfusion, or retrograde coronary sinus perfusion

Cobert¹,

Merritt²,

West³

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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show abstract

“…8,9 In addition to perfusion of capillary beds, RP may also provide partial nutrient flow by perfusion of sinusoids and Thebesian channels. This study examined the use of hypothermic retrograde machine perfusion for a long preservation of donor hearts in a large-animal model of cardiac transplantation.…”

mentioning

confidence: 99%

Successful transplantation in canines after long-term coronary sinus machine perfusion preservation of donor hearts

Brant¹,

Holmes²,

Cobert³

et al. 2016

The Journal of Heart and Lung Transplantation

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Impact of novel intraoperative evaluation for mitral valve regurgitation: the retrograde cardio-protective beating test

et al. 2014

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Continuous retrograde blood cardioplegia is associated with lower hospital mortality after heart valve surgery

Abstract: This study shows that continuous retrograde blood cardioplegia is associated with lower hospital mortality in heart valve operations.

Cited by 11 publications

References 20 publications

Metabolic characteristics of human hearts preserved for 12 hours by static storage, antegrade perfusion, or retrograde coronary sinus perfusion

Metabolic characteristics of human hearts preserved for 12 hours by static storage, antegrade perfusion, or retrograde coronary sinus perfusion

Successful transplantation in canines after long-term coronary sinus machine perfusion preservation of donor hearts

Impact of novel intraoperative evaluation for mitral valve regurgitation: the retrograde cardio-protective beating test

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