Optimal flow rates for integrated cardioplegia

The Journal of Thoracic and Cardiovascular Surgery
V RaoD A Mickle

Abstract

Antegrade cardioplegic delivery may be impaired by coronary occlusions, whereas retrograde delivery of cardioplegic solution may be inhomogeneous, leading to an accumulation of lactate and hydrogen ions, the products of anaerobic metabolism. Integrated cardioplegia using continuous retrograde cardioplegia and antegrade infusions into completed vein grafts washes out metabolites accumulated in regions inadequately perfused by retrograde cardioplegia alone. To determine the flow rates required to achieve the greatest washout, we compared a high flow rate (200 ml/min) to a low flow rate (100 ml/min). Twenty patients scheduled for isolated coronary bypass surgery were prospectively randomized to compare two flow rates for integrated cardioplegic protection using tepid (29 degrees C) blood cardioplegia. Arterial and coronary sinus blood samples were collected to evaluate myocardial metabolism. After antegrade arrest, cardioplegic solution was delivered by coronary sinus perfusion and simultaneous infusions into each completed vein graft at either high or low flow. Increasing from low to high flow increased the washout of lactate and hydrogen ions during the aortic crossclamp period. Two hours after crossclamp removal, ventricular fu...Continue Reading

References

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Citations

Oct 9, 2001·Magnetic Resonance in Medicine : Official Journal of the Society of Magnetic Resonance in Medicine·G TianR Deslauriers
Feb 5, 2004·The Annals of Thoracic Surgery·Yves A G LouagieAndré Gruslin
Dec 10, 1999·The Annals of Thoracic Surgery·G CohenV Rao
Apr 20, 2001·The Annals of Thoracic Surgery·P Ruengsakulrach, B F Buxton
Feb 5, 2008·Critical Care Clinics·Charles W HogueJoshua Stearns
Jan 24, 2009·The Annals of Thoracic Surgery·Manjula MagantiTirone E David
Jun 5, 2007·The Journal of International Medical Research·C OzkaraS Ozcan
Jul 13, 2004·Journal of Cardiac Surgery·Shafie FazelTerrence M Yau

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