Retrograde crystalloid cardioplegia preserves left ventricular systolic function better than antegrade cardioplegia in patients with occluded coronary arteries.
OBJECTIVE
To investigate retrograde and antegrade crystalloid cardioplegia in terms of cardiac cooling and postoperative cardiac function.


METHODS
Prospective, randomized, and blinded.


METHODS
University hospital.


METHODS
Twenty male patients with triple-vessel disease and proximal occlusion of the circumflex or the left anterior descending coronary artery.


METHODS
Left ventricular ejection fraction at rest and during exercise was evaluated by nuclear ventriculography the day before and 3 months after surgery. After induction of anesthesia and hourly for the first 5 postoperative hours, hemodynamic, echocardiographic, and electrocardiographic data were acquired. Myocardial temperature was measured with needle thermistors in 3 myocardial regions.


RESULTS
Demographic and temperature data were analyzed by t-test. Hemodynamic and echocardiographic data were analyzed by analysis of variance. The groups were similar in baseline characteristics. Retrograde cardioplegia cooled the region distal to an occlusion better than antegrade cardioplegia (9.6 degrees C +/- 4.8 degrees C v 21.8 degrees C +/- 5.9 degrees C; p < 0.01). Hemodynamic, echocardiographic, and electrocardiographic data did not differ between the groups. Three months after surgery, the retrograde cardioplegia group showed a higher left ventricular ejection fraction at rest (58% +/- 10% v 47% +/- 10%; p < 0.02) and during exercise (58% +/- 13% v 47% +/- 10%; p < 0.05) compared with the antegrade cardioplegia group.


CONCLUSIONS
Retrograde cardioplegia provides more homogenous myocardial cooling than antegrade cardioplegia in hearts with coronary artery occlusions. The use of retrograde cardioplegia seems to benefit long-term left ventricular function.
Ehrenberg
J
J
Department of Cardiothoracic Surgery and Anaesthesiology, Huddinge Hospital, Sweden.
Intonti
M
M
Owall
A
A
Brodin
L A
LA
Ivert
T
T
Lindblom
D
D
D002314:Cardioplegic Solutions; D003327:Coronary Disease / Q000601:surgery*; D004311:Double-Blind Method; D004452:Echocardiography; D004569:Electroencephalography; D006324:Heart Arrest, Induced / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D017680:Potassium Compounds; D011446:Prospective Studies; D013318:Stroke Volume; D013599:Systole; D016277:Ventricular Function, Left
D002314:Cardioplegic Solutions; D017680:Potassium Compounds; C018369:potassium cardioplegic solution