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Ann Thorac Surg 1991;51:408-412
© 1991 The Society of Thoracic Surgeons

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Articles

Superiority of retrograde cardioplegia after acute coronary occlusion

Department of Cardiothoracic Surgery, Boston University Medical Center, Boston, Massachusetts USA

Accepted for publication October 30, 1990.

^_* Address reprint requests to Dr Lazar, Department of Cardiothoracic Surgery, University Hospital, 88 E Newton St, Boston, MA 02118.

Because antegrade cardioplegia may limit the distribution of cardioplegia beyond a coronary occlusion, this study was undertaken to determine whether retrograde coronary sinus cardioplegia provides superior myocardial protection during revascularization of an acute coronary occlusion. In 20 adult pigs, the second and third diagonal branches were occluded with a snare for [equation] hours. Animals were then placed on cardiopulmonary bypass and underwent 30 minutes of ischemic arrest with multidose, potassium, crystalloid cardioplegia. In 10 animals, the cardioplegia was given antegrade through the aortic root, whereas in 10 others, it was given retrograde through the coronary sinus. After the arrest period, the coronary snares were released and all hearts were reperfused for 3 hours. Postischemic damage in the myocardium beyond the occlusions was assessed by wall motion scores using two-dimensional echocardiography (4 = normal to –1 = dyskinesia), the change in myocardial pH from preischemia, and the area of necrosis/area of risk (histochemical staining). Hearts protected with retrograde coronary sinus cardioplegia had less tissue acidosis (change in pH = 0.08 ± 0.03 versus 0.41 ± 0.13; p < 0.05), higher wall motion scores (2.0 ± 0.6 versus 1.3 ± 0.3; not significant), and less myocardial necrosis (43.4% ± 3.6% versus 73.3% ± 3.5%; p < 0.0001). We conclude that retrograde coronary sinus cardioplegia provides more optimal myocardial protection than is possible with antegrade cardioplegia after revascularization of an acute coronary occlusion.

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