Does simultaneous antegrade and retrograde cardioplegia improve functional recovery and myocardial homeostasis?
BACKGROUND
The purpose of our research was to evaluate the functional recovery and homeostasis of myocardium during simultaneous continuous retrograde and antegrade cardioplegia versus continuous retrograde cardioplegia.


METHODS
Forty patients who underwent elective coronary artery bypass grafting (CABG) were prospectively assigned to two clinically matched groups and analyzed in respect to cardioplegia protocol. Group I consisted of 24 patients who received continuous retrograde blood cardioplegia; Group II consisted of 16 patients who received simultaneous continuous ante- and retrograde cardioplegia. Hydrogen ion release, carbon dioxide, lactate concentration oxygen content, and oxygen extraction were measured from coronary sinus effluent and from the arterial line before and after cross-clamping of the aorta. Median changes of these parameters were reported. Cardiac output was measured and left and right ventricle stroke works were calculated. Incidence of low cardiac output, ventricular fibrillation, raised cardiac enzymes, and ischemic changes on electrocardiogram (ECG) were noted.


RESULTS
In the simultaneous group, oxygen content and oxygen extraction recovered well after cross-clamping. The same parameters did not recover to the same extent in the retrograde group. These changes were notable between groups. Hydrogen ion, carbon dioxide, and lactate releases were comparable between groups. Trend toward better recovery of left ventricle stroke work index was encountered in the simultaneous group.


CONCLUSIONS
Viability of myocardium measured with oxygen utilization and functional recovery is better preserved with simultaneous antegrade and retrograde cardioplegia. However, there is no difference in anaerobic metabolism markers. Thus simultaneous ante- and retrograde cardioplegia is probably advantageous over retrograde alone.
Jasinski
M J
MJ
Department of Cardiothoracic Surgery, Glenfield Hospital, Leicester, United Kingdom. marek.jasinski@glenfield-tr.trent.nhs.uk
Wos
S
S
Kadziola
Z
Z
Wenzel-Jasinska
I A
IA
Spyt
T J
TJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery; D002245:Carbon Dioxide / Q000097:blood; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000378:metabolism* / Q000601:surgery*; D005260:Female; D006324:Heart Arrest, Induced; D006439:Hemodynamics / Q000502:physiology; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*
D002245:Carbon Dioxide; D019344:Lactic Acid; D010100:Oxygen