Technique

Technique: Continuous Retrograde Cardioplegia Followed by Warm Blood Antegrade Infusion

Miami Heart Institute, Miami, Florida

^* Address Communications to: Ernest A. Traad, M.D .. P.A., 1150 N. W 14th St., Suite 207, Miami, FL 33136 or John M.Ingram, BS, CCP,l4120 Harpers Ferry St., Davie, FL 33325

Abstract

The optimum myocardial preservation technique during cardiopulmonary bypass procedures remains widely debated. It is believed that the efficacy of the myocardial preservation technique is largely responsible for post-operative myocardial function and recovery.

At the Miami Heart Institute, a recently developed technique has been under investigation. It is the purpose of this report to reveal the latest research findings on what we believe to be a superior form of myocardial preservation.

Fifty patients who underwent cardiac operations were randomly selected for this study. In each patient, the technique of retrograde cardioplegia was employed. The cardioplegia was administered continuously in retrograde fashion in order to maintain a myocardial temperature range of 6° - 12°C throughout the ischemic period. Shortly before aortic cross clamp removal, warm pump blood was administered antegrade fashion through the aortic root. Aortic root pressure was strictly maintained between 75 - 85 mmHg to insure adequate infusion into the coronary arteries.

The result of the retrograde technique has been strict mainteance of myocardial hypothermia throughout the ischemic period. The antegrade warm blood infusion permits adequate myocardial reperfusion and rewarming. The result of this warm blood infusion has been a spontmteous reinstitution of of the patient's cardiac rhythm without a fibrillation period. Of patients undergoing this technique, 94% experienced no cardiac fibrillation at any time during the operation. While marked improvement in post-operative myocardial function has been observed and is currently under data accumulation, it is our conclusion that this technique is a significant advancement in the field of myocardial preservation (J. Extra-Corpor Technol, 21(2): 56-60, 1989, 15 Ref).