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Ann Thorac Surg 1978;25:407-412
© 1978 The Society of Thoracic Surgeons

Articles

Intraoperative Changes in Coronary Resistance During Aortic Valve Replacement

Pentti Kärkölä, M.D., Erkki Saarela, M.D., Seppo Tuononen, M.D., Risto Pokela, M.D., Lauri Nuutinen, M.D., Matti I. Kairaluoma, M.D., Teuvo K.I. Larmi, M.D.*

Departments of Surgery and Anesthesiology, University of Oulu, Oulu, Finland

Accepted for publication November 2, 1977.

* Address reprint requests to Dr. Larmi, Department of Surgery, University Central Hospital, SF-90220 Oulu 22, Finland

Coronary vascular resistance was investigated in 10 patients undergoing aortic valve replacement using continuous constant-pressure coronary perfusion at 32°C. After coronary flow was initiated, resistance was low but increased steadily until it reached a certain resting level. The plateau was attained faster after a short period of anoxia than after a longer period. The initial postischemic resistance was dependent on the duration of preceding anoxia, being of the same magnitude after short and moderate periods of anoxia but significantly higher after a long period. This resistance difference between the groups lasted for the whole perfusion.

The total coronary resistance and flow reached a plateau in 30 minutes, while resistance increased threefold but flow decreased to half of the initial postanoxia flow.

Our results indicate the importance of initiating coronary perfusion soon after aortic cross-clamping to avoid increase in the initial vascular resistance and subsequent inadequate myocardial flow.






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