Editorial/review

Retrograde Coronary Sinus Versus Antegrade Cardioplegic Perfusion: A Review

Cardiopulmonary Perfusion Resources, Ltd. Mechanicsburg, PA

^* Address correspondence to: David A. James, CCP, 6218 West Shores Rd., Orange Park, FL 32073

Abstract

Retrograde coronary sinus perfusion may provide equal if not better myocardial protection than antegrade cardioplegia during certain heart surgeries.

The coronary venous system can be divided into the greater and lesser systems and veno-venous and arterio-venous anastomoses. Venous drainage varies greatly and retrograde coronary sinus perfusion depends on this variation.

Antegrade cardioplegia is effective in some severely obstructed vasculature due to collaterals but generally these are insufficient and areas of the heart remain unprotected.

The coronary venous system is a low pressure system unaffected by atherosclerosis. Great care must be taken to avoid overpressurization. Because direct cannulation can be difficult, Fabiani created a technique whereby the right heart is pressurized causing backflow into the sinus. Diehl combined this right heart approach with a dose of antegrade cardioplegia to stop the heart quickly.

Investigators have compared retrograde coronary sinus perfusion to antegrade cardioplegia using infrared myocardial thermography, microsphere injection, and crystalloid and perfluorocarbon cardioplegia.

Retrograde coronary sinus perfusion remains a viable alternative to antegrade cardioplegia for various cardiac conditions and its application may increase as investigators improve and simplify the technique.