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Ann Thorac Surg 1992;53:965-971
© 1992 The Society of Thoracic Surgeons

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Articles

Coronary sinus cardioplegia: Clinical trial with only retrograde approach

Minneapolis Heart Institute, Minneapolis, Minnesota USA

^_* Address reprint requests to Dr Arom, Minneapolis Heart Institute, 920 E 28th St, Minneapolis, MN 55407 USA.

The cases of 100 consecutive patients who underwent coronary artery bypass grafting with coronary sinus (retrograde) cardioplegia (group R) without the antegrade-retrograde approach were reviewed. To evaluate the safety and the efficacy of this technique, another 100 consecutive patients who underwent a similar procedure but with conventional aortic root (antegrade) cardioplegia (group A) were used as a comparison. The two groups were similar with respect to age, male to female ratio, associated medical problems, extent of coronary artery disease, mean preoperative ejection fraction (0.56 ± 0.13 versus 0.53 ± 0.18), pump time (113.1 ± 43 versus 111.7 ± 38 minutes), aortic cross-clamp time (57.4 ± 20 versus 60.8 ± 23 minutes), number of grafts per patient, level of hypothermia, complication rate, rate of postoperative myocardial infarction (4% versus 3%), and mortality rate (2% versus 2%). Hemodynamic measurements were made 6 hours after operation in 59 patients in group R and 47 patients in group A. The cardiac index, left ventricular stroke work index, and right ventricular stroke work index were better in group R but not significantly so (p > 0.05). However, only 27% of patients in group R required a temporary pacemaker, and only 9% needed inotropic agents after 6 hours of operation in contrast to 51% and 42%, respectively, in group A (p < 0.05). There were no complications from catheter intubation. In group R, right ventricular wall temperature (11° ± 3.6 °C) was higher than the septal (10.8° ± 3.2°C) and left ventricular wall temperstures (9.1° ± 2.8°C) (p > 0.05). Cardioplegia delivery through the coronary sinus alone is safe for clinical use. The technique is simple, provides homogeneous myocardial cooling, and could be a better method of achieving cardioplegia in patients undergoing coronary artery bypass grafting.

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