Does antegrade blood cardioplegia alone provide adequate myocardial protection in patients with left main stem disease?

Abstract

The combined route of intermittent blood cardioplegia allows better results in left main stem disease. Such data are confirmed even in risk subgroups.

Does Combined Antegrade–Retrograde Cardioplegia Have Any Superiority Over Antegrade Cardioplegia?

“…Indeed, myocardial protection is an art which depends largely on the surgeon's experience and skills [1,2]. There is no consensus on using an optimal method for the protection of myocardium during ischaemic arrest, although it has been debated since the beginning of open heart surgery [3]. In patients with severe coronary stenosis (>90%) there might be maldistribution of antegrade cardioplegic solution in the myocardium.…”

Real‐time Visualization and Quantification of Retrograde Cardioplegia Delivery using Near Infrared Fluorescent Imaging

“…Adequate myocardial protection results in reduced incidence of perioperative myocardial damage and preserves left ventricular function in the postoperative period 15,16 . It also reduces the incidence of postoperative atrial fibrillation and lowers the need for inotropes 16,17 . Presently, no non‐invasive methods have been established to visualize the distribution of cardioplegia in real time or direct delivery of cardioplegia intraoperatively.…”

“…15,16 It also reduces the incidence of postoperative atrial fibrillation and lowers the need for inotropes. 16,17 Presently, no non-invasive methods have been established to We have demonstrated that the intraoperative visualization of cardioplegia distribution is possible using the NIR fluorescent dye ICG and existing NIR imaging technology. This method is appealing because it is safe, non-invasive, and can be used in real time.…”

Continuous Coronary Sinus Perfusion Reverses Ongoing Myocardial Damage in Acute Ischemia

“…Cardiac index (CI), indexed systemic vascular resistances, indexed pulmonary vascular resistances (PVRI), and pulmonary capillary wedge pressure (PCWP) were registered before anesthetic induction, 10 min following aortic declamping, at ITU arrival, and at 24 and 48 h postoperatively. Inodilators were started immediately after aortic cross‐clamp removal, always starting with enoximone at a dosage of 5 µg/kg/min (13). The need for continuing enoximone following CPB discontinuation was based on Swan–Ganz monitoring.…”