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Ann Thorac Surg 1996;62:29-30
© 1996 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 300 words of the full text of this article appear below.

See also page 23.

DR SIDNEY LEVITSKY (Boston, MA): Doctor Allen, this is a very interesting presentation of your clinical experience using a combination of antegrade and retrograde cardioplegia. We have been using a modification of the same technique for the past 4 years except we do not use warm induction or a "hot shot." For coronary revascularization procedures, we use cold cardioplegia while performing the distal anastomoses and warm continuous retrograde cardioplegia while performing the proximal anastomoses in association with a single-clamp technique. My question is related to the methodology of your study. There are no controls, either simultaneous controls or matched retrospective controls. Thus, the apparent good results may just be a reflection of your excellent technical surgery and totally unrelated to the method of myocardial protection.

DR ALLEN: I agree that because there is no control group it is impossible to definitely demonstrate that this is a better method of myocardial protection. However, I am not sure any other method of myocardial protection would allow a patient with aortic regurgitation and mitral insufficiency to have his or her aorta cross-clamped for 4 hours and be discharged on the fifth postoperative day. Numerous experimental and clinical studies have examined each method alone, or in combination. For instance, retrograde delivery has been shown to complement antegrade. Adding warm induction or a warm reperfusate ("hot shot") to cold cardioplegic techniques has also been shown to be beneficial. All we have done is to combine ("integrate") all of these various accepted and previously investigated techniques into a comprehensive strategy to limit each method's weaknesses. More importantly, because there are numerous different cardioplegic strategies in clinical use, the question would be which method of myocardial protection should represent the control group. No matter which one we choose, people would complain we did . . . [Full Text of this Article]

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Integrated Cardioplegia Allows Complex Valve Repairs in All Patients

Bradley S. Allen, Diana Murcia-Evans, and Renee S. Hartz
Ann. Thorac. Surg. 1996 62: 23-29. [Abstract] [Full Text]