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Ann Thorac Surg 1991;52:913-917
© 1991 The Society of Thoracic Surgeons

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Articles

Continuous versus intermittent cardioplegia in the presence of a coronary occlusion

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

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

Coronary artery occlusions can alter the distribution of cardioplegia and result in ischemic damage. This study was undertaken to determine whether continuous antegrade cardioplegia delivery would result in colder temperature and provide better washout of acid metabolites than is possible with intermittent antegrade cardioplegia when coronary occlusions are present. Twenty pigs were placed on cardiopulmonary bypass and underwent 2 hours of ischemic arrest with occlusion of the middle left anterior descending coronary artery followed by 1 hour of reperfusion without occlusion of that artery. Ten pigs received intermittent (every 20 minutes) antegrade potassium crystalloid cardioplegia (4 °C), and 10 others had the same solution given continuously (30 mL/min). Cardioplegia distribution was assessed by continuous monitoring of myocardial pH (Khuri pH probe) and temperature in the region beyond the occlusion of the left anterior descending coronary artery. Both cardioplegic techniques resulted in tissue acidosis (continuous group, 6.69 ± 0.08, versus intermittent group, 6.73 ± 0.07; not significant). Average temperature in the left anterior descending coronary artery during arrest was also similar in both groups (continuous group, 18.3 ° ± 0.5 °C, versus intermittent group, 18.2 ° ± 0.5 °C). Because of these metabolic changes, both cardioplegic techniques resulted in abnormal wall motion in the anteroseptal region using two-dimensional echocardiography, but the scores were not significantly different (continuous group, 1.5 ± 0.3, versus intermittent group, 1.6 ± 0.4; 4 = normal to 0 = dyskinesia). We conclude that continuous antegrade cardioplegia delivery fails to enhance the washout of acid metabolites or lower myocardial temperature in the presence of a coronary occlusion and results in no better myocardial protection than can be obtained with an intermittent cardioplegic technique.

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