Simultaneous antegrade and retrograde delivery of continuous warm blood cardioplegia after global ischemia.
OBJECTIVE
Simultaneous delivery of antegrade and retrograde cardioplegia may provide a more homogeneous distribution of cardioplegic solution. It may, however, increase myocardial edema and postcardioplegic myocardial injury. The purpose of this study was to compare simultaneous antegrade-retrograde cardioplegia with antegrade cardioplegia.


METHODS
After 30 minutes of warm, "unprotected," global ischemia, pigs were given warm, continuous blood cardioplegia for 45 minutes (antegrade group, n = 8 and simultaneous antegrade-retrograde group, n = 9). All pigs were weaned from cardiopulmonary bypass 45 to 60 minutes after aortic unclamping. Indices of left ventricular function were measured after another 30 minutes with the conductance catheter technique and pressure-volume loops.


RESULTS
Global left ventricular function, evaluated by preload recruitable stroke work, decreased from baseline values of 126 (102 to 150) (mean [90% confidence limits]) (antegrade) and 122 (116 to 127) erg/ml x 10(3) (simultaneous) to 75 (61 to 89) (p = 0.004) and 95 (79 to 112) erg/ml x 10(3) (p = 0.02), respectively. End-diastolic pressure-volume relation increased from 0.25 (0.21 to 0.28) (antegrade) and 0.30 (0.25 to 0.35) mm Hg/ml (simultaneous) to 0.60 (0.41 to 0.79) (p = 0.009) and 0.53 (0.35 to 0.71) mm Hg/ml (p = 0.02), respectively. The time constant of left ventricular pressure relaxation was unchanged. No intergroup difference was observed in preload recruitable stroke work, preload recruitable stroke work area, end-diastolic pressure volume relation, or stiffness constant. Plasma levels of troponin T increased without any difference between groups. Myocardial water content was increased in the simultaneous group (81.1% [80.7% to 81.5%]) versus the antegrade group (80.1% [79.6% to 80.7%], p = 0.01).


CONCLUSIONS
Despite a small increase in myocardial water content induced by simultaneous blood cardioplegia, no impairment of postcardioplegic cardiac function was observed compared with antegrade cardioplegia.
Ericsson
A B
AB
Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
Takeshima
S
S
Vaage
J
J
D000818:Animals; D015415:Biomarkers / Q000097:blood; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D002315:Cardiopulmonary Bypass; D004195:Disease Models, Animal; D004489:Edema, Cardiac / Q000209:etiology; D006324:Heart Arrest, Induced / Q000379:methods*; D006439:Hemodynamics; D013552:Swine; D014336:Troponin / Q000097:blood; D020107:Troponin T; D016277:Ventricular Function, Left
D015415:Biomarkers; D002314:Cardioplegic Solutions; D014336:Troponin; D020107:Troponin T