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

Radmehr, Hassan; Soleimani, Aliakbar; Tatari, Hasan; Salehi, Mehrdad

doi:10.1016/j.hlc.2008.04.009

Cited by 22 publications

(17 citation statements)

References 10 publications

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“…However, limited data were available, and the methodology of monitoring was different since we had used a Swan-Ganz catheter. Additionally, a previous study highlighted improved cardiac protection with a combination of antegrade and retrograde perfusion that enhanced the distribution of cardioplegia [4].…”

Section: Discussionmentioning

confidence: 99%

“…The retrograde route is particularly interesting in the setting of critical coronary stenosis, severe aortic insufficiency, or other conditions that may alter the antegrade delivery of cardioplegia [1][2][3]. Actually, the mode of delivering cardioplegia depends on the preference of the surgeons, and retrograde cardioplegia is often combined with antegrade delivery to enhance the myocardial protection [4]. Additionally, many surgical reports validated interesting results in redo valvular procedures using a continuous retrograde perfusion of oxygenated blood via the coronary sinus, which allows to perform beating-heart valve surgery with cardiopulmonary bypass (CPB) and decreases the risk of ischemia-reperfusion injury [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Evidences for Inotropism Triggered by Simultaneous Antegrade And Retrograde Myocardial Perfusion in A Swine Model

Grandmougin¹

2019

JICOA

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Keywords:Self Myocardial Retroperfusion (SMR) coronary Circulation left azygos vein inotropism hemodynamics conductance catheter A B S T R A C T Objectives: Retrograde perfusion into the coronary sinus is currently used to deliver cardioplegia. We developed an in-vivo porcine beating-heart model of self-myocardial retroperfusion (SMR) using the venous route to increase myocardial oxygenation of the left ventricle. Then, we sought to assess whether the association of a simultaneous antegrade and retrograde myocardial perfusion with oxygenated blood might trigger hemodynamic and cardiac responses compared with a single antegrade myocardial supply.Methods: A group of 8 pigs was dedicated to undergo SMR with a simultaneous antegrade physiological LAD perfusion. SMR was achieved with a bypass-line between the ascending aorta and the coronary sinus to perform a selective retrograde perfusion of the great cardiac vein with oxygenated blood after ligation of the left azygos vein.Cardiac output (CO), maximal pressure in the LV (Pmax in-LV), stroke volume (SV), left ventricular ejection fraction (LVEF), diastolic durations, heart rate (HR), and arterial systemic pressure were monitored with conductance catheters. These data were collected during the antegrade myocardial perfusion (baseline period) and compared with data recorded during a simultaneous antegrade and retrograde perfusion. At the end of the procedures, the hearts were harvested for histology.Results: SMR with antegrade LAD perfusion showed inotropic properties with significant improvements in CO, SV, Pmax in-LV and LVEF (p<0.0001) compared with baseline values. Histology confirmed no signs of tissular injuries. Conclusions:The selective retrograde perfusion of the great cardiac vein with oxygenated blood combined with an antegrade physiological LAD perfusion showed obvious capacities to trigger inotropic properties opening interesting perspectives.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evidences for Inotropism Triggered by Simultaneous Antegrade And Retrograde Myocardial Perfusion in A Swine Model

Grandmougin¹

2019

JICOA

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“…With the knowledge that the anterior cardiac veins supplying the RV are not directly connected to the coronary sinus and thus may lead to a suboptimal distribution of the cardioplegic solution to the RV [ 12 ],[ 13 ] Kaukoranta et al [ 28 ] conducted a small study on patients undergoing CABG surgery and receiving either antegrade or retrograde cardioplegia and reported that, despite more significant ischaemic changes within the RV in the retrograde cardioplegia group, no post-operative complication related to the retrograde route was observed.…”

Section: Discussionmentioning

confidence: 99%

“…With this technique, the cardioplegic solution is distributed to the cardiac microstructure through a transmural network of veins that is independent to flow-limiting lesions [ 11 ]. Nevertheless, retrograde cardioplegia presents important potential limitations, which could in part explain the reason why its use remains still relatively limited: 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 ]; 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; 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; 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 ].…”

Section: Introductionmentioning

confidence: 99%

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A retrospective analysis of myocardial preservation techniques during coronary artery bypass graft surgery: are we protecting the heart?

Candilio

Malik

Ariti

et al. 2014

J Cardiothorac Surg

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BackgroundRetrograde 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. Peri-operative myocardial injury (PMI), as measured by the rise of serum level of cardiac biomarkers, has been associated with short and long-term clinical outcomes. We conducted a retrospective analysis to investigate whether the combination of antegrade and retrograde techniques of cardioplegia delivery is associated with a reduced PMI than that observed with the traditional methods of myocardial preservation.MethodsFifty-four consecutive patients underwent CABG surgery using either antegrade cold blood cardioplegia (group 1, n = 28) or cross-clamp fibrillation (group 2, n = 16) or antegrade retrograde warm blood cardioplegia (group 3, n = 10). The study primary end-point was PMI, evaluated with total area under the curve (AUC) of high-sensitivity Troponin-T (hsTnT), measured pre-operatively and at 6, 12, 24, 48 and 72 hours post-surgery. Secondary endpoints were acute kidney injury (AKI) and inotrope scores, length of intensive care unit (ICU) and hospital stay, new onset atrial fibrillation (AF) and clinical outcomes at 6 weeks (death, non-fatal myocardial infarction, coronary artery revascularization, stroke).ResultsThere was evidence that mean total AUC of hsTnT was different among the three groups (P = 0.050). In particular mean total AUC of hsTnT was significantly lower in group 3 compared to both group 1 (-16.55; 95% CI: -30.08, -3.01; P = 0.018) with slightly weaker evidence of a lower mean hsTnT in group 3 when compared to group 2 (-15.13; 95% CI -29.87, -0.39; P = 0.044). There was no evidence of a difference when comparing group 2 to group 1 (-1.42,; 95% CI: -12.95, 10.12, P = 0.806).ConclusionsOur retrospective analysis suggests that, compared to traditional methods of myocardial preservation, antegrade retrograde cardioplegia may reduce PMI in patients undergoing first time CABG surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0184-7) contains supplementary material, which is available to authorized users.

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Myocardial Protection

2020

Manual of Perioperative Care in Adult Cardiac Surgery

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

Cited by 22 publications

References 10 publications

Evidences for Inotropism Triggered by Simultaneous Antegrade And Retrograde Myocardial Perfusion in A Swine Model

Evidences for Inotropism Triggered by Simultaneous Antegrade And Retrograde Myocardial Perfusion in A Swine Model

A retrospective analysis of myocardial preservation techniques during coronary artery bypass graft surgery: are we protecting the heart?

Myocardial Protection

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