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J Thorac Cardiovasc Surg 1994;107:510-0519
© 1994 Mosby, Inc.

Cardiopulmonary Bypass, Myocardial Management, and Support Techniques

Optimal flow rates for retrograde warm cardioplegia

Toronto, Ontario, Canada

From the Division of Cardiovascular Surgery, the Department of Clinical Biochemistry, and the Centre for Cardiovascular Research, The Toronto Hospital and the University of Toronto, Toronto, Ontario, Canada.

Supported by the Medical Research Council of Canada (Grant MT-9829). Dr. Ikonomidis is a Fellow of the Medical Research Council of Canada; Dr. Yau is a Fellow of the Heart and Stroke Foundation of Canada; Dr. Weisel is a Career Investigator of the Heart and Stroke Foundation of Ontario.

Presented at the Sixty-fifth Scientific Sessions of the American Heart Association, New Orleans, La., Nov. 16, 1992.

Received for publication Feb. 18, 1993. Accepted for publication June 29, 1993. Address for reprints: Richard D. Weisel, MD, The Toronto Hospital, EN 14-215, 200 Elizabeth St., Toronto, Ontario M5G 2C4.

Abstract

Retrograde delivery of warm blood cardioplegia may improve nutrient cardioplegic flow beyond coronary obstructions, but may not adequately perfuse the right ventricle and the posterior left ventricle. To determine the optimal flow rate for warm retrograde cardioplegia, we assessed 62 patients undergoing elective coronary artery bypass in two studies. In the low flow study, administration of 50 ml/min (n = 9), 75 ml/min (n = 11), or 100 ml/min (n = 7) was associated with high lactate production and oxygen extraction during cardioplegic administration. At 50 minutes of cardioplegic arrest, the coronary venous effluent pH was low in all groups. In the high flow study, 30 patients all received flow rates of 100, 200, and 300 ml/min in randomized order during the crossclamp period. In addition, five patients received cardioplegia at a rate of 500 ml/min for the duration of the crossclamp period. Administration of 200 ml/min or higher minimized lactate production and maintained coronary venous pH within the physiologic range, but flows of 300 ml/min or higher did not increase oxygen use or reduce lactate or acid production. Patients in the low flow groups had significantly greater myocardial lactate release during cardioplegic infusion and after removal of the crossclamp than the high flow group. Warm retrograde cardioplegia should be delivered at flow rates of at least 200 ml/min during elective coronary artery bypass operations. (J THORAC CARDIOVASC SURG1994;107:510-9)

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