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The Annals of Thoracic Surgery, Vol 49, 556-563, Copyright © 1990 by The Society of Thoracic Surgeons
P Menasche, JB Subayi and A Piwnica
Retrograde delivery of cardioplegic solutions has recently been the subject
of renewed interest, but the reliability of this technique has not been
assessed in large clinical series. From 1980 to 1989, we used retrograde
coronary sinus perfusion as the exclusive means of cardioplegia delivery in
500 consecutive patients undergoing aortic valve replacement, either
isolated (359 patients) or combined with another valve or coronary
procedure (141 patients). The coronary sinus was always cannulated under
direct vision after bicaval cannulation with snaring. Cold crystalloid
cardioplegia was delivered retrogradely at an average flow rate of 100
mL/min in conjunction with topical and systemic (25 degrees C) hypothermia.
The mean cross-clamp time was 83 +/- 23 minutes (+/- the standard
deviation). There were 31 hospital deaths (6.2%), 20 of which were cardiac
related. Transient hemodynamic instability (defined as a need for inotropic
agents for less than 24 hours postoperatively) occurred in 16 patients
(3.2%), whereas a true low-output syndrome developed in 60 patients (12%).
The incidence of clinically significant supraventricular arrhythmias and of
permanent conduction defects was 7.4% and 1.2%, respectively. There were
three nonfatal coronary venous injuries during our early experience. We
conclude that coronary sinus perfusion is a safe and effective means of
delivering cardioplegia in aortic valve operations. While providing a
degree of myocardial protection similar to that reported with anterograde
cardioplegia, the coronary sinus technique offers distinct advantages, in
particular, the avoidance of perfusion-related coronary artery
complications and the opportunity to repeat cardioplegia administration
without interrupting the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Retrograde coronary sinus cardioplegia for aortic valve operations: a clinical report on 500 patients
Department of Cardiovascular Surgery, Hopital Lariboisiere, Paris, France.
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