BACKGROUND: It has been suggested that the right ventricular myocardium is suboptimally protected during retrograde blood cardioplegia. METHODS:Twenty patients undergoing an elective coronary bypass procedure were randomized to receive antegrade or retrograde mild hypothermic blood cardioplegia. Transventricular differences in oxygen extraction, lactate production, and pH were monitored during aortic cross-clamping, and myocardial biopsy specimens were taken from both ventricles before cannulation and 15 minutes after aortic declamping for analysis of adenine nucleotides and their breakdown products. The extent of myocardial injury was estimated by monitoring postoperative leakage of troponin T and the MB isoenzyme of creatine kinase. Hemodynamic recovery and postoperative complications were noted. RESULTS: The preoperative characteristics of the two groups were similar. Oxygen extraction and lactate production in the right ventricular myocardium were higher in the retrograde group. In this group, the right ventricle also extracted more oxygen and produced more lactate and acid than did the left ventricle. Tissue levels of adenine nucleotides tended to decrease in both ventricles during operation, with no differences between them. The level of adenosine catabolites did increase somewhat in the right ventricular myocardium of the retrograde cardioplegia group after aortic declamping. There was a tendency for more prominent efflux of troponin T and the MB isoenzyme of creatine kinase in the retrograde group. Nevertheless, the postoperative course was uneventful in both groups. CONCLUSIONS:Retrograde mild hypothermic blood cardioplegia leads to metabolic changes compatible with right ventricular ischemia. Nevertheless, tissue levels of high-energy phosphates are well preserved, and the postoperative course seems to be unproblematic. Care should be taken when retrograde normothermic blood cardioplegia is provided for patients with right ventricular hypertrophy, poor right ventricular function, or severe preoperative myocardial ischemia.
RCT Entities:
BACKGROUND: It has been suggested that the right ventricular myocardium is suboptimally protected during retrograde blood cardioplegia. METHODS: Twenty patients undergoing an elective coronary bypass procedure were randomized to receive antegrade or retrograde mild hypothermic blood cardioplegia. Transventricular differences in oxygen extraction, lactate production, and pH were monitored during aortic cross-clamping, and myocardial biopsy specimens were taken from both ventricles before cannulation and 15 minutes after aortic declamping for analysis of adenine nucleotides and their breakdown products. The extent of myocardial injury was estimated by monitoring postoperative leakage of troponin T and the MB isoenzyme of creatine kinase. Hemodynamic recovery and postoperative complications were noted. RESULTS: The preoperative characteristics of the two groups were similar. Oxygen extraction and lactate production in the right ventricular myocardium were higher in the retrograde group. In this group, the right ventricle also extracted more oxygen and produced more lactate and acid than did the left ventricle. Tissue levels of adenine nucleotides tended to decrease in both ventricles during operation, with no differences between them. The level of adenosine catabolites did increase somewhat in the right ventricular myocardium of the retrograde cardioplegia group after aortic declamping. There was a tendency for more prominent efflux of troponin T and the MB isoenzyme of creatine kinase in the retrograde group. Nevertheless, the postoperative course was uneventful in both groups. CONCLUSIONS: Retrograde mild hypothermic blood cardioplegia leads to metabolic changes compatible with right ventricular ischemia. Nevertheless, tissue levels of high-energy phosphates are well preserved, and the postoperative course seems to be unproblematic. Care should be taken when retrograde normothermic blood cardioplegia is provided for patients with right ventricular hypertrophy, poor right ventricular function, or severe preoperative myocardial ischemia.
Authors: Beth Unsworth; Roberto P Casula; Andreas A Kyriacou; Hemang Yadav; Andrew Chukwuemeka; Ashok Cherian; Rex de Lisle Stanbridge; Thanos Athanasiou; Jamil Mayet; Darrel P Francis Journal: Am Heart J Date: 2010-02 Impact factor: 4.749
Authors: Dmitry I Kurapeev; Viktor O Kabanov; Vadim K Grebennik; Tatyana A Sheshurina; Vladimir V Dorofeykov; Michael M Galagudza; Eugene V Shlyakhto Journal: J Cardiothorac Surg Date: 2015-01-22 Impact factor: 1.637
Authors: Luciano Candilio; Abdul Malik; Con Ariti; Sherbano A Khan; Matthew Barnard; Carmelo Di Salvo; David R Lawrence; Martin P Hayward; John A Yap; Amir M Sheikh; Christopher G A McGregor; Shyam K Kolvekar; Derek J Hausenloy; Derek M Yellon; Neil Roberts Journal: J Cardiothorac Surg Date: 2014-12-31 Impact factor: 1.637
Authors: Marco Zanobini; Matteo Saccocci; Gloria Tamborini; Fabrizio Veglia; Alessandro Di Minno; Paolo Poggio; Mauro Pepi; Francesco Alamanni; Claudia Loardi Journal: Biomed Res Int Date: 2017-05-14 Impact factor: 3.411
Authors: Philipp Szalkiewicz; Maximilian Y Emmert; Paul P Heinisch; Zsuzsanna Arnold; Ingo Crailsheim; Markus Mach; Thomas Aschacher; Martin Grabenwöger; Bernhard Winkler Journal: Front Cardiovasc Med Date: 2022-07-28