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Ann Thorac Surg 2001;72:1572-1575
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Does warm blood retrograde cardioplegia preserve right ventricular function?

Pankaj Kulshrestha, MDa, John A. Rousou, MD*a, Richard M. Engelman, MDa, Joseph E. Flack, III, MDa, David W. Deaton, MDa, Richard B. Wait, MDa, Heather M. Hampf, BSa

a Division of Cardiac Surgery, Department of Surgery, The Baystate Medical Center, Springfield, Massachusetts, USA

Accepted for publication July 31, 2001.

* Address reprint requests to Dr Rousou, Division of Cardiac Surgery, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199, USA
e-mail: cardiac51{at}worldnet.att.net

Background. Efficacy of warm blood retrograde cardioplegia in preserving right heart function remains controversial. The current study was conducted to gauge the preservation of right ventricular function after warm blood retrograde cardioplegia.

Methods. We studied 75 consecutive patients undergoing isolated heart valve procedures with warm blood retrograde cardioplegia as the exclusive mode of preservation. Right ventricular radionuclide ejection fraction and hemodynamic measurements using a pulmonary artery catheter were calculated before and within 3 days after operation.

Results. Postoperative radionuclide right ventricular ejection fraction was well preserved at 0.4686 ± 0.0122 compared with 0.4327 ± 0.0255 preoperatively (p = 0.7064). Right ventricular systolic work index improved from 5.82 ± 0.52 to 8.97 ± 0.60 g-m/m2 (p < 0.0001) and cardiac index increased from 2.40 ± 0.09 to 2.92 ± 0.11 L/m2 (p < 0.0001). When right ventricular systolic work index was correlated with preload, 30 patients moved up and down on the same ventricular function curve and 42 moved to a higher inotropic curve postoperatively. Only 3 patients demonstrated decreased inotropy.

Conclusions. In the clinical setting warm blood retrograde cardioplegia used as the exclusive mode of myocardial preservation provides adequate protection of the right heart.




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