A NEW SIMPLIFIED METHOD OF OPTIMIZING CARDIOPLEGIC DELIVERY WITHOUT RIGHT HEART ISOLATION - ANTEGRADE RETROGRADE BLOOD CARDIOPLEGIA

  • 1 July 1990
    • journal article
    • research article
    • Vol. 100  (1) , 56-64
Abstract
We report our initial experience with antegrade/retrograde cardioplegia using a self-inflating/deflating balloon cannula that allows rapid transatrial retrograde cannulation of the coronary sinus (10 to 15 seconds) without right heart isolation and permits routine single venous cannulation. We subjected 141 consecutive adult patients and nine children to antegrade/retrograde cardioplegia using rapid transatrial insertion of the Retroplegia cannula (Research Medical, Inc., Salt Lake City, Utah). Single venous cannulation was used in 116 patients having coronary artery bypass grafting or aortic valve replacement, or both. Initial antegrade blood cardioplegia caused immediate arrest (< 1 minute) and the cardioplegic dose was divided equally between antegrade and retrograde delivery. Included are 95 patients having isolated bypass grafting (34 with extending infarction, cardiogenic shock, or ejection fraction < 20%); 19 having coronary reoperations, 42 with aortic or mitral valve procedures, or both; and nine children having repair of congenital defects (e.g., repair of ventricular septal defect, Rastelli operation, Konno operation). Septal temperature in patients with occlusion of the left anterior descending coronary artery fell to 11.5.degree. .+-. 0.5.degree.C after retrograde cardioplegia versus only 16.degree. .+-. 3.degree.C after antegrade cardioplegia (p < 0.05). The overall hospital mortality rate was 2% and no complications followed transatrial retrograde cannulation of the coronary sinus.