Risk factors of incomplete distribution of cardioplegic solution during coronary artery grafting

Abstract

Myocardial distribution of cardioplegic solution infused by combined antegrade/retrograde routes was assessed with myocardial contrast echocardiography in 18 patients with chronic stable angina and three-vessel disease undergoing elective coronary artery bypass grafting. Overall myocardial opacification was significantly greater in retrograde than in antegrade cardioplegia (77.7% +/- 13.4% versus 59.1% +/- 15.7%; p = 0.0009). The difference was affected by collateral circulation, as pointed out by the significant interaction between coronary collateral circulation and percent of myocardial opacification after antegrade and retrograde cardioplegia (p = 0.002). When we performed multiple comparisons, in patients with good collaterals the opacification difference between antegrade and retrograde cardioplegia was not statistically significant (66.4% +/- 10.2% versus 76.0% +/- 15.2%; p = not significant), whereas in patients with poor collaterals myocardial opacification during retrograde cardioplegia was significantly greater (44.3% +/- 15.0% versus 81.2% +/- 9.0%; p < 0.02). During antegrade cardioplegia, patients with poor collaterals showed a lower degree of myocardial opacification than patients with good collaterals (44.3% +/- 15.0% versus 66.4% +/- 10.2%; p < 0.01). Our results show that retrograde cardioplegia in patients undergoing elective coronary artery bypass grafting offers no advantage over antegrade cardioplegia when collateral circulation is well developed. On the other hand, conventional aortic root infusion may not provide adequate myocardial protection in the subset of patients with significantly narrowed or occluded coronary arteries and poor collaterals.

Comparison of Isothermic Continuous Retrograde Blood Cardioplegia vs. Intermittent Antegrade Blood Cardioplegia in Isolated CABG Surgery Patients

“…Kardiyoplejinin antegrad ya da retrograd verilmesindeki dezavantajlar, cerrahın ameliyat sırasındaki kardiyopleji kullanım tercihinde önemli rol oynamaktadır. Aort yetmezliği, ciddi proksimal koroner arter lezyonları ve redo olgulardaki önceki greftler, antegrad kardiyopleji kullanımını kısıtlayabilir (9) . Antegrad aralıklı 20 şer dakikalık kardiyopleji uygulamaları, total perfüzyon zamanını ve aortik kros klemp süresini de uzatmaktadır.…”

Optimal Continuous Retrograde Coronary Perfusion Flow Rate with Beating Heart in Normal Temperature

“…There have been reports which document cases that showed retrograde perfusion to be less efficient than antegrade perfusion in protecting normal regions of the myocardium (8,9). There is a report that documents cases that showed hypoperfusion of the right ventricle to be one of the causes of the right ventricle failure (10).…”

Antegrade-Retrograde Cardioplegia for Myocardial Protection during Coronary Artery Bypass Graft Surgery

“…Experimental and clinical studies have demonstrated that critical stenosis of the coronary arteries may prevent homogenous distribution of cardioplegic solution when it is injected through the aortic root, which may contribute to the higher incidence of perioperative myocardial infarction observed in such patients. [17][18][19][20][21] Retrograde coronary sinus perfusion was first introduced by Lillehei and colleagues 22 in 1956 to facilitate surgery on the aortic valve. In the late 1970s, interest emerged in the coronary sinus as a route for delivery of cardioplegia.…”