Technique

Technical Aspects of Simultaneous Antegrade/Retrograde Normothermic Blood Cardioplegia

St. Michael's Hospital, Department of Cardiovascular Perfusion, Toronto, Ontario, Canada

^* Address correspondence to: Zahir Young, ACP, CPC, St. Michael's Hospital, Department of Cardiovascular Perfusion, 30 Bond Street, Toronto, Ontario, MSB 1 W8 Canada

Abstract

Techniques of myocardial protection are a source of controversy in the field of cardiac surgery. Numerous studies have been carried out over the years to prove or disprove one method over another. The following techniques: cold vs. warm, antegrade vs. retrograde, and intermittent vs. continuous are some of the most controversial. Cold intermittent antegrade blood cardioplegia has been an accepted routine for many years. However, the use of warm blood cardioplegia has recently sparked much interest, and many studies have recognized its advantages over cold methods.

If cardioplegia is given intermittently, regardless of any other variables, there will be some degree of ischemia with a resultant delay in myocardial recovery. A logical solution to avoid this ischemia is to deliver oxygenated substrate enhanced warm blood cardioplegia continuously and simultaneously via antegrade and retrograde routes for improved regional distribution. This combined technique is described.