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The Annals of Thoracic Surgery, Vol 57, 403-406, Copyright © 1994 by The Society of Thoracic Surgeons
CA Caldarone, IB Krukenkamp, BD Misare and S Levitsky
Prior studies of cold retrograde cardioplegia have demonstrated the
existence of regional deficits in perfusate delivery. To address the
hypothesis that these deficits persist with the use of warm perfusate,
cardioplegic arrest was induced in 7 swine hearts with retrograde warm
blood cardioplegia. Regional perfusion was assessed with the simultaneous
infusion of colored 10-microns microspheres. The percentage microsphere
recovery (regional microsphere count/total number of microspheres counted x
100) was greatest in the anterior (43% +/- 4%) and lateral (35% +/- 6%)
left ventricle. The microsphere recoveries in the posterior left ventricle
(7% +/- 1%) and anterior septum (14% +/- 4%) were intermediate, and were
statistically lower than those in the anterior left ventricle (p <
0.01). The lateral right ventricle (0.6% +/- 0.2%) and the posterior septum
(1.4% +/- 0.9%) exhibited minimal perfusion versus that in the anterior
left ventricle (p < 0.01). Less than 1% of the infused microspheres were
recovered in the aortic root; 67% were recovered in the right ventricle and
are presumed to have bypassed the microcirculation as nonnutritive flow.
These data demonstrate that cold retrograde perfusion patterns persist
during retrograde warm blood cardioplegia. Limited perfusion of the right
ventricle and the posterior septum as well as a large nonnutritive flow
were also noted. These perfusion deficits in metabolically active arrested
hearts may limit myopreservation at low cardioplegia flow rates.
ARTICLES
Perfusion deficits with retrograde warm blood cardioplegia
Division of Cardiothoracic Surgery, New England Deaconess Hospital/Harvard Medical School, Boston, MA 02215.
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