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The Annals of Thoracic Surgery, Vol 51, 418-423, Copyright © 1991 by The Society of Thoracic Surgeons
P Menasche, JB Subayi, L Veyssie, O le Dref, S Chevret and A Piwnica
Myocardial areas distal to complete coronary artery occlusions are poorly
protected by antegrade cardioplegia. We assessed the effects of coronary
sinus cardioplegia in 30 patients undergoing bypass operations and at high
risk of cardioplegic maldistribution because of the following anatomical
patterns of coronary artery disease: critical (greater than or equal to
50%) stenosis of the left main trunk with total occlusion of the right
coronary artery (16 patients) or critical (greater than or equal to 70%)
stenosis of the right coronary artery with total occlusion of the left
anterior descending (11 patients) or circumflex artery (3 patients). After
induction of arrest through the aorta, coronary sinus cardioplegia was
given intermittently during the cross-clamp period at a flow rate of 100
mL/min. Intraoperatively, occluded arteries were consistently found to be
filled with the retrogradely infused solution. One patient died early
postoperatively of low cardiac output and a second patient died later
during his hospital stay, presumably of an arrhythmia. At autopsy, none of
them had pathological evidence of inadequate myocardial protection. One
patient sustained a myocardial infarction and 3 others required inotropes
for more than 24 hours postoperatively. Postoperative values for right and
left stroke volume indices were not significantly different from prebypass
levels. Overall, these results are consistent with the occurrence of
limited intraoperative ischemic damage and, by inference, suggest the
efficacy of the coronary sinus route in preserving myocardial areas
supplied by completely occluded coronary arteries and, hence, in jeopardy
of inadequate cardioplegia delivery.
ARTICLES
Efficacy of coronary sinus cardioplegia in patients with complete coronary artery occlusions
Department of Cardiovascular Surgery, Hopital Lariboisiere, Paris, France.
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