title: A comparison of distribution between simultaneously or sequentially delivered antegrade/retrograde blood cardioplegia.
abstract: Commercially available cardioplegia delivery systems now allow for antegrade (aortic root, coronary ostia, saphenous vein graft) perfusion to occur either sequentially or simultaneous with retrograde (coronary sinus) perfusion. This study was designed to compare the total flow and local distribution of sequential versus simultaneous antegrade/retrograde cardioplegia delivery.
  
  
  METHODS
  Explanted human hearts diagnosed with idiopathic cardiomyopathy underwent a cold cardioplegic arrest and bicaval cardiectomy. Thirty-seven degree centigrade blood cardioplegia containing colored microspheres was then delivered antegrade (red color) at a pressure of 80 mmHg or retrograde (blue color) at a pressure of 40 mmHg. In the sequential group (n = 6), cardioplegia was delivered antegrade and then retrograde for 2 minutes, respectively. For the simultaneous group (n = 6), cardioplegia was delivered both antegrade and retrograde for 2 minutes. The ventricular myocardium was then sampled at 12 representative sites to determine regional cardioplegic flow.
  
  
  RESULTS
  Mean total cardioplegia delivery/minute was 0.69 +/- 0.62 mL/g per minute for sequential cardioplegia, and 0.46 +/- 0.19 mL/g per minute for simultaneous cardioplegia (p > 0.05, NS). At the 12 ventricular sites sampled, mean regional cardioplegic flow (mL/g per min) was in general slightly greater for sequential delivery. However, this was not statistically significant (p > 0.05, NS).
  
  
  CONCLUSIONS
  The data suggest that there may be a slight advantage in total cardioplegia delivery and regional cardioplegia delivery when using sequential rather than simultaneous cardioplegia delivery. However, this difference was not statistically significant and is likely not of clinical significance. Therefore, we would recommend using either sequential or simultaneous antegrade/retrograde cardioplegia based upon whichever technique facilitates the conduct of the individual operation.
authors.affiliation: Department of Surgery, UCLA Medical Center 90024, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.forename: R N
authors.initials: RN
authors.lastname: Gates
authors.forename: H
authors.initials: H
authors.lastname: Laks
authors.forename: D C
authors.initials: DC
authors.lastname: Drinkwater
authors.forename: E
authors.initials: E
authors.lastname: Rhudis
authors.forename: A
authors.initials: A
authors.lastname: Aharon
authors.forename: A
authors.initials: A
authors.lastname: Ardehali
authors.forename: P
authors.initials: P
authors.lastname: Chang
mesh_terms: D001011:Aorta; D001769:Blood; D006348:Cardiac Surgical Procedures; D009202:Cardiomyopathies / Q000473:pathology / Q000601:surgery; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D003326:Coronary Circulation; D003331:Coronary Vessels; D006324:Heart Arrest, Induced / Q000379:methods*; D006346:Heart Septum / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007036:Hypothermia, Induced; D008863:Microspheres; D009206:Myocardium / Q000473:pathology; D011312:Pressure; D012501:Saphenous Vein / Q000637:transplantation
chemical_list: D002314:Cardioplegic Solutions