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Ann Thorac Surg 1997;64:887
© 1997 The Society of Thoracic Surgeons

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Correspondence

The Value of Minicardioplegia in the Clinical Setting

Division of Cardiovascular Surgery, Shady Side Hospital Medical Center, Suite 216, 5200 Center Ave, Pittsburgh, Pa 15232

To the Editor:

Our great interest in Dr Menasché's editorial on blood cardioplegia in the October 1996 issue of The Annals [1] led us to study the method Dr Menasché and his associates have described [2] and to use an adaptation of this method for minicardioplegia in 20 patients who underwent cardiac operations at our institution.

The 20 patients in our series underwent operation for coronary artery bypass graft placement or valve replacement (2 for the second time) or (in 1 patient) to manage left main coronary artery dissection after percutaneous transluminal coronary angioplasty. In all but 1 patient (whose aortic valve was replaced through an upper median sternotomy as described by Gundry at the Thirty-third Annual Meeting of The Society of Thoracic Surgeons in February 1997), we instituted cardiopulmonary bypass through a standard median sternotomy incision. We then instituted antegrade cardioplegia by cross-clamping the aorta and using octopus system (CDS004WV; Research Medical, Midvale, UT) to administer 20 mL of potassium-magnesium solution with 300 to 600 mL of blood cooled to between 30° and 32°C into the aortic root. Myocardial standstill was consistently achieved after infusion of the first 10 mL of potassium-magnesium solution.

After induction, cardioplegia was maintained by delivering blood at 100 mL/min and cardioplegia solution at 60 mL/h (flow rates adjusted independently depending on myocardial activity) through a retrograde cardioplegia catheter (14F; NPC014T; Research Medical) placed in the coronary sinus. The temperature of the cardioplegia blood was maintained at 30°C and the body temperature was maintained at 33° to 35°C, depending on the estimated length of the operation. For all patients undergoing coronary artery bypass grafting, we administered antegrade cardioplegia through the saphenous vein graft while maintaining retrograde cardioplegia. The total aortic cross-clamp time ranged between 35 and 108 minutes and the total volume of crystalloid (postassium-magnesium solution) infused ranged between 37 and 90 mL.

We are very pleased with the results of minicardioplegia in the 20 patients in this series. Minicardioplegia has the following advantages over the 4:1 cardioplegia solutions we used previously:

1. Administering blood rather than crystalloid solutions into the myocardium provides nutrients to the muscle and decreases the cost of solutions used for cardioplegia.
   
2. Administering less crystalloid solution decreases the risk of myocardial edema and was associated with spontaneous recovery from cardioplegia.
   
3. Use of less crystalloid solution led to less hemodilution, decreased risk of fluid overload, and faster normalization of clotting time after administration of protamine sulfate, resulting in decreased bleeding and decreased use of blood or blood products.
   
4. The duration of vasopressor use decreased.
   

Our results using minicardioplegia for a variety of cardiac surgical procedures lead us to recommend this technique over 4:1 cardioplegia in all cases.

Addendum

Since we wrote this letter we have used the same technique in an additional 400 patients, and we are pleased with the clinical results and outcomes using minicardioplegia.

References

1. Menasché P. Blood cardioplegia: do we still need to dilute? Ann Thorac Surg 1996;62:957–60.[Free Full Text]
2. Menasché P, Touchot B, Pradier F, Bloch G, Piwnica A. Simplified method for delivering normothermic blood cardioplegia. Ann Thorac Surg 1993;55:177–8.[Abstract/Free Full Text]

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Venkat R. Machiraju Claudio A. B. Lima Michael H. Culig Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Machiraju, V. R. Articles by Culig, M. H. Search for Related Content PubMed PubMed Citation Articles by Machiraju, V. R. Articles by Culig, M. H.