Retrograde cardioplegia infusion during coronary bypass surgery. Early clinical experience.
Although aortic root cardioplegia infusion has been generally satisfactory, adequate myocardial protection in patients with critical coronary artery disease (CAD) cannot always be achieved by this route. We report our experience with our first 19 consecutive patients, all with exceptionally severe disease in whom the coronary sinus route was utilized for cardioplegia infusion. Eleven had unstable angina, and three had persistent chest pain requiring intensive antianginal therapy right up to time of surgery. Blood cardioplegia was infused via the coronary sinus using a Foley Catheter under a monitored pressure of 30 mmHg. Ischemic time was 83 +/- 27 minutes. Number of vessels bypassed was 4.9 +/- 0.9. Prebypass hemodynamic profile was compared to the profile at 15 and 75 minutes, and at 6, 12 and 24 hours after cessation of bypass, and revealed good preservation of myocardial function: Cardiac index, stroke volume index and pulmonary capillary wedge pressure remained unchanged, systemic vascular resistance decreased by 30%, while changes of lesser magnitude were observed in systemic and pulmonary blood pressure. There was no death and one perioperative myocardial infarction. Myocardial temperature was monitored by needle thermisters and demonstrated homogeneous myocardial cooling in spite of the severity of CAD. Thus, preservation of cardiac function even in patients with critical and extensive CAD can be achieved by coronary sinus infusion of cardioplegia.
Shapira
N
N
Section of Cardiovascular Surgery, Medical Center of Delaware, Christiana Hospital, Newark.
Turner
P E
PE
Morse
D
D
Lemole
G M
GM
D000328:Adult; D000368:Aged; D001769:Blood; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D003331:Coronary Vessels; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic