Antegrade/retrograde cardioplegia for valve replacement: a prospective study.
BACKGROUND
From 1994 to 1996, 75 patients undergoing valve replacement were randomized to antegrade (36 patients, group 1) or antegrade/retrograde (39 patients, group 2) administration of cold blood cardioplegia.


METHODS
Groups were comparable for age, sex, valve disease, and ventricular dysfunction. The aortic valve was replaced in 27 patients from group 1 and 24 patients from group 2, the mitral valve in 8 and 15 patients, and 1 patient in group 1 underwent double valve replacement (p = not significant).


RESULTS
Lengths of cardiopulmonary bypass and aortic cross-clamp averaged, respectively, 10 minutes (p = not significant) and 12 minutes (p = < 0.05) shorter in group 2. Total amount of cardioplegia solution infused averaged 1,279 +/- 406 mL and 1,341 +/- 379 mL (p = not significant), respectively, in groups 1 and 2, and the period of infusion averaged 44% and 72% (p = < 0.01) of the total period of aortic cross-clamping. No death occurred in group 1 compared to two in group 2 (p = not significant). The perioperative myocardial infarction and stroke rates were comparable in both groups. Peak enzyme release at 24 hours was similar both for creatine kinase-MB fraction (26 versus 37 IU/L) and for troponin T (2.1 versus 2.5 IU/L).


CONCLUSIONS
Our study shows no significant advantage of the antegrade/retrograde administration of cardioplegia over the antegrade route in routine valvular replacement, other than a slightly shorter aortic cross-clamping time.
Dagenais
F
F
Department of Surgery, Montreal Heart Institute, University of Montreal, Quebec, Canada.
Pelletier
L C
LC
Carrier
M
M
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
D002314:Cardioplegic Solutions