Retrograde coronary sinus versus aortic root perfusion with cold cristalloid cardioplegia: A prospective randomized study in the hypertrophied heart

C. Fucci, R. Confortini, M. Ferrari, G. Coletti, A. Manzato, F. Maisano, S. Curello, R. Ferrari, O. Alfieri

Research output: Contribution to journalArticlepeer-review

Abstract

In patients undergoing myocardial revascularization procedures, de livery of cardioplegic solution through the coronary sinus has proved to be more effective than through the antegrade route. There are no comparative studies demonstrating superior regional or global myocardial protection with retrograde cardioplegia in the hypertrophied heart without concomitant coronary artery disease. We attempted to characterize metabolic and hemodynamic changes occurring in the hypertrophied ventricle during aortic valve replacement using antegrade, retrograde and antegrade-retrograde cold cardioplegic techniques. Fifteen patients were prospectively randomized into three groups according to routes of cardioplegic solution delivery. Five patients (group I) received cold cristalloid cardioplegic solution (St. Thomas) via the aortic root, five (group II) received cardioplegic solution via the coronary sinus and five (group III) had a retrograde/antegrade cardioplegic delivery. Hemodynamic measurements included cardiac output, mean aortic pressure, pulmonary capillary wedge pressure, right atrial pressure and heart rate. Metabolic measurements included myocardial arteriovenous (arterial and coronary sinus blood) differences for lactate and creatine phosphokinase (CPK). There was no hemodynamic and metabolic difference between the groups. We conclude that these results support a more liberal use of the retrograde route for these patients: It does not interrupt the surgical procedure if the cardioplegic solution has to be reinfused and, under these circumstances, avoids the possible damage due to direct cannulation of the coronary arteries.

Original languageEnglish
Pages (from-to)64-68
Number of pages5
JournalCor Europaeum - European Journal of Cardiac Interventions
Volume5
Issue number2
Publication statusPublished - 1996

Keywords

  • Hypertrophied heart
  • Myocardial protection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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