Efficacy of coronary sinus cardioplegia in patients with complete coronary artery occlusions

Menasché, Philippe; Subayi, J. B.; Veyssié, Line; Dref, Olivier Le; Chevret, Sylvie; Piwnica, A

doi:10.1016/0003-4975(91)90857-m

Cited by 78 publications

(32 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since its approval in 1958, ICG has had a remarkable safety record with minimal adverse reactions. 12,13 Standard cold (4°C), hyperkalemic crystalloid cardioplegia was used in this study and consisted of 154 mmol sodium, 154 mmol of chloride, 4 mEq of MgSO 4 , and 40 mEq of KCl per liter. 100 μg of ICG was added to 150 ml of cardioplegia solution resulting in a 860 nM final injection concentration.…”

Section: Nir Fluorophores and Cardioplegiamentioning

confidence: 99%

“…Retrograde delivery of cardioplegia through the coronary sinus has a theoretical advantage in patients with high-grade coronary lesions since it might supply regions of the myocardium inaccessible by the antegrade route. 4 Retrograde cardioplegia, though, suffers from poor preservation of the right ventricle 5 , regional heterogeneity, and a significant delay before diastolic arrest. 6 Often, a combination of antegrade and retrograde delivery techniques is used to optimize myocardial protection.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Image-Guided Quantification of Cardioplegia Delivery during Cardiac Surgery

Soltesz¹,

Laurence²,

Grand³

et al. 2007

The Heart Surgery Forum

View full text Add to dashboard Cite

Objectives-Homogenous distribution of cardioplegia delivered to the myocardium has been identified as an important predictor of post-cardiopulmonary bypass ventricular recovery and function. Presently, a method to determine adequate distribution of cardioplegia in patients during cardiac surgery does not exist. The goal of this study was to evaluate the feasibility of quantifying cardioplegia delivery using a novel, non-invasive optical method. Such a system would permit instantaneous imaging of jeopardized myocardium and allow immediate, intraoperative corrective measures.Methods-We have previously developed a portable, intraoperative near-infrared (NIR) fluorescence imaging system for use in large animal cardiac surgery, which simultaneously displays color video and NIR fluorescent images of the surgical field. By introducing exogenous, non-isotopic NIR fluorophores, specific cardiac functions can be visualized in real-time.Results-In a cardiopulmonary bypass porcine model, we demonstrate that the FDA-approved intravascular fluorophore indocyanine green (ICG) permits real-time assessment of cardioplegia delivery. ICG was injected into an aortic root and/or transatrial coronary sinus catheter during delivery of cold crystalloid cardioplegia solution. Segmental distribution was immediately noted at the time of injection. In a subset of animals, simulated coronary occlusions resulted in imaging defects consistent with poor cardioplegia delivery and jeopardized myocardium. Videodensitometric analysis was performed on-line to quantify right and left ventricular (RV, LV) distribution.Conclusions-We report the development of a novel, non-invasive, intraoperative technique which can easily and safely provide a visual assessment of cardioplegia delivery (antegrade and/or retrograde) and which offers the potential to quantify the relative segmental distribution during cardiac surgical procedures.ULTRAMINI ABSTRACT-Intraoperative near-infrared fluorescence imaging is a novel, noninvasive technique that can safely and easily visualize and quantify cardioplegia distribution during cardiac surgery. This system should permit surgeons to identify regions of poor myocardial protection, and guide interventions, intraoperatively and in real-time.

show abstract

Section: Nir Fluorophores and Cardioplegiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Image-Guided Quantification of Cardioplegia Delivery during Cardiac Surgery

Soltesz¹,

Laurence²,

Grand³

et al. 2007

The Heart Surgery Forum

View full text Add to dashboard Cite

show abstract

“…Rough blind manoeuvering of the cardioplegic cannula is very dangerous, and there have been reports of coronary artery ostial dissection [1] and pseudoaneurysms possibly caused by the tip of the cardioplegic cannula [2]. Retrograde administration of cardioplegic solution through the coronary sinus is another possibility for inducing cardioplegia, especially when there is critical stenosis of the coronary arteries [3,4]. However, some studies criticise retrograde administration of cardioplegic solution and highlight the major associated problems, such as poor protection of the right ventricle [5,6].…”

Section: Discussionmentioning

confidence: 99%

A dental mirror provides excellent exposure of the right coronary artery during cardioplegia

Matsushita

Masuda

Inoue

2011

Heart, Lung and Circulation

View full text Add to dashboard Cite

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Aziz

Khaja²,

Ali³

et al. 1998

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

This prospective randomized clinical study was designed to assess and compare the use of combined antegrade-retrograde cardioplegia versus antegrade cardioplegia in providing adequate myocardial preservation during coronary artery bypass graft surgery. Fifty patients undergoing elective coronary artery bypass grafting were randomly divided into 2 groups according to the route of cardioplegic delivery: group A (25 patients) received antegrade cold crystalloid cardioplegia; group B (25 patients) received combined antegrade-retrograde cold crystalloid cardioplegia. The groups were compared by clinical and electrocardiographic criteria and biochemical markers of ischemic myocardial damage. There was a highly significant statistical difference between the groups in terms of spontaneous recovery of sinus rhythm (40% of patients in group A versus 96% in group B). The use of direct current shock to restore sinus rhythm was higher in group A (60%) compared with group B (4%). Low cardiac output occurred in 20% of patients in group A and in 16% of patients in group B but this difference was not statistically significant. No bundle-branch block was found in group B whereas the incidence was 8% in group A. Significantly higher levels of biochemical markers of myocardial damage were obtained in group A at 10 minutes, 4 hours, and 12 hours after declamping. These results indicate that combined antegrade-retrograde cardioplegia is superior to antegrade cardioplegia for myocardial protection during coronary artery bypass graft surgery.

show abstract

Efficacy of coronary sinus cardioplegia in patients with complete coronary artery occlusions

Cited by 78 publications

References 16 publications

Image-Guided Quantification of Cardioplegia Delivery during Cardiac Surgery

Image-Guided Quantification of Cardioplegia Delivery during Cardiac Surgery

A dental mirror provides excellent exposure of the right coronary artery during cardioplegia

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

Contact Info

Product

Resources

About