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J Thorac Cardiovasc Surg 1996;112:787-796
© 1996 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

ANTEGRADE AND RETROGRADE CARDIOPLEGIA: ALTERNATE OR SIMULTANEOUS?

Supported by the Medical Research Council of Canada (grant MT9825). J.S.I. is a Fellow of the Heart and Stroke Foundation of Canada; V.R. is a Pharmaceutical Roundtable Fellow of the Heart and Stroke Foundation of Canada; R.D.W. is a Career Investigator of the Heart and Stroke Foundation of Ontario.

Presented to the American Heart Association, Anaheim, Calif., November, 1995.

Received for publication Nov. 27, 1995 Revisions requested Jan. 16, 1996; revisions received Feb. 13, 1996; Accepted for publication Feb. 21, 1996. Address for reprints: Richard D. Weisel, MD, The Toronto Hospital, 200 Elizabeth St., EN 14-215, Toronto, Ontario, M5G 2C4, Canada.

Abstract

Neither antegrade nor retrograde cardioplegic protection provides homogeneous distribution, and a combination may be required to avoid anaerobic metabolism and depressed postoperative ventricular function. Tepid cardioplegia (29° C) avoids the delayed recovery of cardiac function and metabolism associated with cold cardioplegia (15° C) and reduces the anaerobic metabolism seen with warm (37° C) cardioplegia. We compared two techniques that combine antegrade and retrograde tepid cardioplegia: alternate and simultaneous. Methods:Sixty patients undergoing elective isolated coronary artery bypass grafting were randomized to receive near continuous tepid retrograde and either intermittent antegrade cardioplegia (the alternate technique) or antegrade cardioplegia with the solution delivered concurrently through each completed vein graft (the simultaneous technique). Results:Myocardial lactate extraction was greater after crossclamp release following simultaneous than alternate cardioplegia. Postoperative ventricular function was better after alternate than simultaneous cardioplegia. Conclusion:Both techniques permitted rapid postoperative recovery of myocardial metabolism and ventricular function. However, simultaneous cardioplegia was simpler and did not require deairing the aortic root between antegrade infusions. (J THORAC CARDIOVASC SURG 1996;112:787-96)

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