Myocardial perfusion during warm antegrade and retrograde cardioplegia: A contrast echo study

被引:18
作者
Borger, MA
Wei, KS
Weisel, RD
Ikonomidis, JS
Rao, V
Cohen, G
Shirai, T
Omran, AS
Siu, SC
Rakowski, H
机构
[1] Toronto Gen Hosp, Div Cardiovasc Surg, Toronto, ON M5G 2C4, Canada
[2] Toronto Gen Hosp, Div Cardiol, Toronto, ON M5G 2C4, Canada
[3] Univ Toronto, Toronto, ON, Canada
关键词
D O I
10.1016/S0003-4975(99)00797-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. We evaluated distribution of warm antegrade and retrograde cardioplegia in patients undergoing coronary artery bypass grafting (CABG). Methods. Myocardial perfusion was evaluated pre- and post-CABG using transesophageal echocardiography with injection of sonicated albumin microbubbles (Albunex) during warm antegrade and retrograde cardioplegia. The left ventricle (LV) was evaluated in five segments and the right ventricle (RV) was evaluated in two segments. Segmental contrast enhancement was graded as absent (score = 0), suboptimal or weak (score = 1), optimal or excellent (score = 2), or excessive (score = 3). Results. Pre-CABG cardioplegic perfusion correlated weakly with severity of coronary artery stenoses (r = 0.331 and 0.276 for antegrade and retrograde cardioplegia, respectively). Antegrade cardioplegia administration resulted in 98% and 96% perfusion to the left ventricle pre- and post-CABG, respectively. Retrograde cardioplegic administration resulted in reduced LV perfusion, with 86%, (p = 0.032 from antegrade) and 59% (p < 0.001 from antegrade) pre- and post-CABG, respectively. The average LV perfusion score (mean +/- SEM) was greater with antegrade than retrograde cardioplegia both pre-CABG (1.93 +/- 0.04 vs 1.53 +/- 0.11, p < 0.001) and post-CABG (1.63 +/- 0.07 vs 1.19 +/- 0.13, p = 0.004). RV perfusion was poor with both techniques pre-CABG, but improved significantly with antegrade cardioplegia post-CABG. Conclusions. We conclude that warm antegrade cardioplegia results in better left ventricular perfusion than warm retrograde cardioplegia. Right ventricular cardioplegic perfusion was suboptimal, but the best delivery was achieved with antegrade cardioplegia after coronary bypass. We therefore recommend construction of the saphenous vein graft to the right coronary artery early in the operative procedure. (Ann Thorac Surg 1999;68:955-61) (C) 1999 by The Society of Thoracic Surgeons.
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页码:955 / 961
页数:7
相关论文
共 23 条
[1]   RETROGRADE CARDIOPLEGIA DOES NOT ADEQUATELY PERFUSE THE RIGHT VENTRICLE [J].
ALLEN, BS ;
WINKELMANN, JW ;
HANAFY, H ;
HARTZ, RS ;
BOLLING, KS ;
HAM, J ;
FEINSTEIN, S .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1995, 109 (06) :1116-1126
[2]   Iatrogenic myocardial edema: Increased diastolic compliance and time course of resolution in vivo [J].
Amirhamzeh, MMR ;
Dean, DA ;
Jia, CX ;
Cabreriza, SE ;
Starr, JP ;
Sardo, MJ ;
Chalik, N ;
Dickstein, ML ;
Spotnitz, HM .
ANNALS OF THORACIC SURGERY, 1996, 62 (03) :737-743
[3]   The influence of collateral flow on the antegrade and retrograde distribution of cardioplegia in patients with an occluded right coronary artery [J].
Aronson, S ;
Jacobsohn, E ;
Savage, R ;
Albertucci, M .
ANESTHESIOLOGY, 1998, 89 (05) :1099-1107
[4]   MYOCARDIAL DISTRIBUTION OF CARDIOPLEGIC SOLUTION AFTER RETROGRADE DELIVERY IN PATIENTS UNDERGOING CARDIAC SURGICAL-PROCEDURES [J].
ARONSON, S ;
LEE, BK ;
ZAROFF, JG ;
WIENCEK, JG ;
WALKER, R ;
FEINSTEIN, S ;
KARP, RB .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1993, 105 (02) :214-221
[5]   PERFUSION DEFICITS WITH RETROGRADE WARM BLOOD CARDIOPLEGIA [J].
CALDARONE, CA ;
KRUKENKAMP, IB ;
MISARE, BD ;
LEVITSKY, S .
ANNALS OF THORACIC SURGERY, 1994, 57 (02) :403-406
[6]  
Caretta Q, 1993, Cardiologia, V38, P431
[7]  
DORSEY LM, 1983, J THORAC CARDIOV SUR, V86, P70
[8]   ADEQUATE DISTRIBUTION OF WARM CARDIOPLEGIC SOLUTION [J].
HAYASHIDA, N ;
IKONOMIDIS, JS ;
WEISEL, RD ;
SHIRAI, T ;
IVANOV, J ;
CARSON, S ;
MOHABEER, MK ;
TUMIATI, LC ;
MICKLE, DAG .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1995, 110 (03) :800-812
[9]  
HIRATA N, 1992, J THORAC CARDIOV SUR, V104, P1158
[10]   OPTIMAL FLOW-RATES FIX RETROGRADE WARM CARDIOPLEGIA [J].
IKONOMIDIS, JS ;
YAU, TM ;
WEISEL, RD ;
HAYASHIDA, N ;
FU, XP ;
KOMEDA, M ;
IVANOV, J ;
CARSON, S ;
MOHABEER, MK ;
TUMIATI, L ;
MICKLE, DAG .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1994, 107 (02) :510-519