Optimal flow rates for integrated cardioplegia

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Presentation transcript:

Optimal flow rates for integrated cardioplegia Vivek Rao, MD, Gideon Cohen, MD, Richard D. Weisel, MD, Noritsugu Shiono, MD, PhD, Yoshiki Nonami, MD, PhD, Susan M. Carson, AHT, Joan Ivanov, RN, MSc, Michael A. Borger, MD, Robert J. Cusimano, MD, Donald A. Mickle, MD The Journal of Thoracic and Cardiovascular Surgery Volume 115, Issue 1, Pages 226-235 (January 1998) DOI: 10.1016/S0022-5223(98)70461-1 Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1 Study protocol for comparing flow rates. After antegrade arrest by way of the aortic root, continuous retrograde delivery was instituted through the coronary sinus at a flow rate of 100 ml/min. Cardioplegic flow was interrupted whenever necessary to visualize the distal anastomosis. After completion of the first distal anastomosis, the cardioplegic solution was delivered both retrogradely and antegradely into the vein graft at a flow rate of 100 ml/min for 1 minute, then at 200 ml/min for 1 minute. Simultaneous antegrade and retrograde delivery of the cardioplegic solution was then given at either low (100 ml/min) or high (200 ml/min) flow for the remainder of the procedure. XCL, Aortic crossclamp; CPB, cardiopulmonary bypass; LITA, left internal thoracic artery. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 226-235DOI: (10.1016/S0022-5223(98)70461-1) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 2 Top panel, Percent change in lactate and acid production and oxygen consumption after the addition of antegrade cardioplegic perfusion into the completed right coronary artery graft. Bottom panel, Percent change in lactate and acid production and oxygen consumption achieved by increasing the flow rate from 100 ml/min (low) to 200 ml/min (high). Myocardial oxygen consumption significantly increased as the flow rate increased. Similarly, increasing the cardioplegic flow rate significantly increased lactate and acid washout. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 226-235DOI: (10.1016/S0022-5223(98)70461-1) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 3 Panel A, Myocardial lactate release after completion of each distal anastomosis. Washout of accumulated lactate was higher in patients receiving high cardioplegic flow rates after the second distal anastomosis. The difference between high and low flow rates dissipated as additional vein grafts became perfused (p = 0.088 by two-way ANOVA). Panel B, Myocardial oxygen consumption after completion of each distal anastomosis. Oxygen consumption was higher in patients receiving high cardioplegic flow rates after the first distal anastomosis. This difference dissipated as additional vein grafts became perfused (p = 0.158 by two-way ANOVA). Panel C, Myocardial acid release after completion of each distal anastomosis. Washout of accumulated hydrogen ions was higher in patients receiving high cardioplegic flow rates (p = 0.034 by two-way ANOVA) (mean ± standard error of the mean). The Journal of Thoracic and Cardiovascular Surgery 1998 115, 226-235DOI: (10.1016/S0022-5223(98)70461-1) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 4 Panel A, Cardiac index at baseline (PRE), 2, 4, 8, and 24 hours postoperatively. Cardiac index was greater in the high flow group (hollow symbols ; p = 0.03 by ANOCOVA). LVEDP, Left ventricular end-diastolic pressure (mm Hg). Panel B, Left ventricular stroke work index (LVSWI) at baseline (PRE), 2, 4, 8, and 24 hours postoperatively. LVSWI was greater in the high flow group (hollow symbols; p = 0.05 by ANOCOVA). PCWP, Pulmonary capillary wedge pressure (mm Hg). The Journal of Thoracic and Cardiovascular Surgery 1998 115, 226-235DOI: (10.1016/S0022-5223(98)70461-1) Copyright © 1998 Mosby, Inc. Terms and Conditions