Antegrade and retrograde cardioplegia: Alternate or simultaneous?

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Antegrade and retrograde cardioplegia: Alternate or simultaneous? Toshizumi Shirai, MD, Vivek Rao, MD, Richard D. Weisel, MD, John S. Ikonomidis, MD, PhD, Nobuhiko Hayashida, MD, Joan Ivanov, RN, MSc, Susan Carson, AHT, Molly K. Mohabeer, BSc, Donald A.G. Mickle, MD, MSc The Journal of Thoracic and Cardiovascular Surgery Volume 112, Issue 3, Pages 787-796 (September 1996) DOI: 10.1016/S0022-5223(96)70066-1 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 Cardioplegic technique. The techniques of alternate and simultaneous antegrade cardioplegia during semicontinuous retrograde cardioplegia are depicted. CPB, Cardiopulmonary bypass; XCL, aortic crossclamp; SVG, saphenous vein graft; LITA, left internal thoracic artery graft; PROX, proximal anastomoses of vein grafts; ANTE, initial antegrade delivery. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 787-796DOI: (10.1016/S0022-5223(96)70066-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 Myocardial metabolism during cardiac arrest. Myocardial oxygen consumption (MVO2), lactate release, and acid release (AR) at 10, 30, and 50 minutes of crossclamp time are illustrated. Oxygen consumption was greater during intermittent antegrade cardioplegia in the alternate group (p < 0.001 by ANOVA). Myocardial lactate release was greater with simultaneous cardioplegia than with continuous retrograde cardioplegia in the alternate group (p = 0.005 by ANOVA). Myocardial acid release was greatest with intermittent antegrade cardioplegia (p = 0.007 by ANOVA). The Journal of Thoracic and Cardiovascular Surgery 1996 112, 787-796DOI: (10.1016/S0022-5223(96)70066-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Myocardial metabolism during reperfusion. Myocardial oxygen extraction, lactate extraction, and acid release before aortic crossclamping, immediately, 5, and 10 minutes after crossclamp removal, and 5 and 10 minutes after discontinuation of cardiopulmonary bypass are illustrated. Lactate extraction recovered more quickly in the simultaneous group than in the alternate group (p = 0.03 by ANOVA), and lactate extraction was greater 10 minutes on cardiopulmonary bypass and 10 minutes after cardiopulmonary bypass. No differences in oxygen extraction or acid release were detected between groups. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 787-796DOI: (10.1016/S0022-5223(96)70066-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Postoperative cardiac function. The relation between left ventricular stroke work index (LVSWI) or cardiac index (CI), and pulmonary capillary wedge pressure (PCWP) is depicted. Left ventricular stroke work index decreased in both groups after the operation (time p < 0.0001). The decrease was greater in the simultaneous group than the alternate group (p = 0.04 by analysis of covariance). Stroke work index was lower in the simultaneous group 4 hours after the operation at a higher wedge pressure. Cardiac index increased (time p = 0.017) similarly in both groups after the operation. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 787-796DOI: (10.1016/S0022-5223(96)70066-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Postoperative cardiac function. The relation between left ventricular stroke work index (LVSWI) or cardiac index (CI), and pulmonary capillary wedge pressure (PCWP) is depicted. Left ventricular stroke work index decreased in both groups after the operation (time p < 0.0001). The decrease was greater in the simultaneous group than the alternate group (p = 0.04 by analysis of covariance). Stroke work index was lower in the simultaneous group 4 hours after the operation at a higher wedge pressure. Cardiac index increased (time p = 0.017) similarly in both groups after the operation. The Journal of Thoracic and Cardiovascular Surgery 1996 112, 787-796DOI: (10.1016/S0022-5223(96)70066-1) Copyright © 1996 Mosby, Inc. Terms and Conditions