Why retrograde cardioplegia

With growing experience using retrograde cardioplegia, numerous studies have shown that this technique anterograde with retrograde cardioplegia provides a superior return of myocardial function in the distribution of the occluded coronary vessels than with antegrade cardioplegia alone. Retrograde cardioplegia has been shown to be superior at protecting the hypertrophied subendocardium than antegrade cardioplegia alone. During aortic valve procedures, retrograde cardioplegia allows flushing of debris from the coronary ostia, as well as de-airing of the coronaries and aortic root with the final dose.

In the operating room, retrograde cardioplegia monitoring is often via pressure monitoring. This pressure is displayed with the vital signs and often visible on a screen to all personnel in the operating room. All providers, nurses, techs, perfusionists, etc. Since coronary sinus rupture being a catastrophic event, it is imperative to avoid such an outcome. It is essential to discuss the utilization of retrograde cardioplegia preoperatively so that the necessary equipment is available to include a catheter, cardioplegia solution, and monitoring equipment.

The Annals of thoracic surgery. Journal of the American College of Cardiology. Lazar HL, Coronary sinus interventions during cardiac surgery. The Journal of thoracic and cardiovascular surgery. Case reports in anesthesiology. Gundry SR,Kirsh MM, A comparison of retrograde cardioplegia versus antegrade cardioplegia in the presence of coronary artery obstruction.

Journal of cardiothoracic and vascular anesthesia. Gundry SR, Modification of myocardial ischemia in normal and hypertrophied hearts utilizing diastolic retroperfusion of the coronary veins. Eng J,Munsch C, Retrograde cardioplegia.

Retrograde Cardioplegia. Continuing Education Activity To ensure the protection of the heart during cardiopulmonary bypass, administration and even distribution of cardioplegia solution to the myocardium is imperative. In five patients undergoing aortic valve replacement, right and left coronary ostial drainage was estimated during retrograde infusion.

Before the aortic crossclamp was removed, myocardial oxygen extraction was calculated in all 15 patients by first delivering warm blood cardioplegic solution for 2 minutes in a retrograde fashion and then taking samples from the cardioplegia line and aortic root. This determined the oxygen extraction ratio across the myocardium at the end of retrograde delivery. Warm blood cardioplegic solution was next given antegrade, and 15 seconds later samples were taken from the cardioplegia line and a right ventricular acute marginal vein to determine the oxygen extraction ratio across the right ventricle.

Oxygen extraction across the myocardium supplied by retrograde infusion was low after 2 minutes. Asian Cardiovasc Thorac Ann. Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Neil Roberts. LC and AM carried out the study, acquired, analysed and interpreted data. LC, AM. CA performed the statistical analysis. DJH, NR read and approved final manuscript. All authors read and approved the final manuscript. Reprints and Permissions. Candilio, L.

A retrospective analysis of myocardial preservation techniques during coronary artery bypass graft surgery: are we protecting the heart?. J Cardiothorac Surg 9, Download citation. Received : 13 August Accepted : 19 November Published : 31 December Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Research article Open Access Published: 31 December A retrospective analysis of myocardial preservation techniques during coronary artery bypass graft surgery: are we protecting the heart? Abstract Background Retrograde perfusion into coronary sinus during coronary artery bypass graft CABG surgery reduces the need for cardioplegic interruptions and ensures the distribution of cardioplegia to stenosed vessel territories, therefore enhancing the delivery of cardioplegia to the subendocardium.

Conclusions Our retrospective analysis suggests that, compared to traditional methods of myocardial preservation, antegrade retrograde cardioplegia may reduce PMI in patients undergoing first time CABG surgery. Background The prompt delivery of cardioplegic solution to all regions of the heart during cardiac surgery is essential for successful myocardial protection [ 1 ]. Nevertheless, retrograde cardioplegia presents important potential limitations, which could in part explain the reason why its use remains still relatively limited: 1 the anterior cardiac veins supplying the right ventricle RV are not directly connected to the coronary sinus and this may lead to a suboptimal distribution of the cardioplegic solution to the RV [ 12 ],[ 13 ]; 2 accurate cannulation of the coronary sinus is crucial as failure in this might lead to the distribution of the cardioplegic solution to the right atrium and not to the venous system; 3 the perfusion pressure requires very close monitoring, as too low a pressure suggests misplacement of the cannula, and too high a pressure can cause rupture of the coronary sinus [ 14 ],[ 15 ].

These potential issues can generally be avoided by care and precision by the surgeon; 4 the delay in arresting the heart due to slow retrograde perfusion if retrograde cardioplegia is used alone lower flow rates and pressures used to prevent coronary sinus damage and myocardial oedema [ 16 ],[ 17 ].

Methods Study design We conducted a retrospective analysis of patients undergoing first time CABG surgery recruited between December and July as a subgroup of control patients in a large parallel single-blinded randomised controlled clinical trial carried out at the Heart Hospital, University College London Hospital London, UK , and investigating the effects of remote ischaemic preconditioning RIPC [ 4 ],[ 5 ] in patients undergoing cardiac surgery.

Surgical procedure Temazepam mg was given one hour prior to surgery. Objectives To determine whether the addition of retrograde cardioplegia to standard antegrade cardioplegia can reduce PMI and subsequently improve short-term clinical outcomes in patients undergoing first time CABG surgery compared to patients receiving either standard antegrade cardioplegia alone or cross-clamp fibrillation.

Secondary end-points included: 1. Length of ICU and hospital stay; 4. New onset of AF in the three post-operative days; 5. Results Included patients were recruited into an original RIPC trial enrolling a total of subjects of which 90 patients were randomised to control: 36 patients were subsequently excluded 1 patient died intra-operatively and the remaining 35 underwent CABG and valve surgery or valve surgery alone.

Table 1 Patient baseline characteristics Full size table. Figure 1. Full size image. Figure 2. Table 3 Summary of study secondary endpoints Full size table. Discussion Myocardial preservation during cardiac surgery is certainly one of the most debated topics in this field.

Conclusions Our study suggests that, compared to traditional methods of myocardial preservation, the combined use of retrograde and antegrade cardioplegia may have the potential to reduce PMI in patients undergoing first-time CABG surgery.

References 1. CAS Google Scholar Article PubMed Google Scholar Acknowledgements Maria Xenou for identification of patients for recruitment.

All staff at the Heart Hospital, London. View author publications. Additional information Competing interests The authors declare that they have no competing interests. All authors read and approved the final manuscript Luciano Candilio, Abdul Malik contributed equally to this work. About this article. Cite this article Candilio, L.

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