Objective To investigate the effects on myocardial perfusion of simultaneous antegrade/retrograde cardiopiegia （SARC） through a single coronary artery and coronary sinus （CS）. Methods SARC was conducted in isolated pig hearts through CS in conjunction with the left anterior descending （LAD）, the left circumflex （LCX）, or the right coronary artery （RCA） respectively. After injecting magnetic resonance （MR） contrast agent （gadolinium diethyienetriamine pentaacetic acid, Gd-DTPA） into arterial or venous route, the distribution of Gd-DTPA with magnetic resonance imaging（MRI） was monitored and the effluent from the venting coronary arteries to assess the efficacy of SARC for myocardial perfusion was measured. Results Injection of Gd-DTPA into a perfusing artery during SARC resulted in increased signal intensity not only in the territory of the perfusing artery but also in the areas normally served by the other two venting coronary arteries （including the right ventrieuiar free wall）. With Gd DTPA given into the CS during SARC, the myocardium in the territories of the two venting coronary arteries was lightened. Signal intensity of the myocardium in the perfusing artery territory and right ventricuiar free wall remained unchanged. Moreover, a significant amount of effluent was collected from the venting coronary arteries during SARC： the LAD 10.5-17.7 ml/min; LCX 9.7-15.2 ml/min, and RCA 4.7-7.8 ml/min. Conclusion SARC through a single coronary artery and CS can provide homogeneous perfusion to the entire heart and is sufficient to prevent ischemic injury in the myocardium normally supported by the venting coronary arteries.
Objective To analyze the effect of myocardial protection between modified Del Nido cardioplegia and St. Thomas Hospital Cardioplegia in adult patients with aortic valve and mitral valve replacement. Methods From January 2014 to June 2016, 140 patients underwent aortic valve and mitral valve replacement in our hospital. According to different cardioplegia, the patients were divided into two groups including a modified Del Nido cardioplegia group (70 patients, 37 males, 33 females at mean age of 53.13±9.52 years) and a St. Thomas cardioplegia group (70 patients, 32 males, 38 females, at age of 50.71±9.29 years). We collected clinical data of the patients before operation (T1), 2 h after aortic unclamping (T2), 24 h after operation (T3) and 48 h after operation (T4). Indexes of muscle enzymes including blood center creatine kinase (CK), creatine kinase isoenzyme (CK-MB) concentration and liver function indexes including urea nitrogen (BUN), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST) concentrations, and compared the postoperative and follow-up clinical data. Results There was no statistical difference in age, weight, gender, ejection fraction baseline data between the two groups (P>0.05). All patients were successfully completed combined valve replacement under cardiopulmonary bypass. The cardiopulmonary time was no statistical difference between the two groups (P>0.05). However, compared with St. Thomas cardioplegia group, modified Del Nido group was less in perfusion (1.19±0.39vs. 2.99±0.75, P<0.001), shorter in aortic clamping time (P=0.003). No statistical difference was found in defibrillation rate after resuscitation between the two groups (P=0.779). Biochemical indicators were not statistically different at different time points between the two groups (P>0.05). Conclusion Modified Del Nido cardioplegia has the same effect on myocardial protection with St. Thomas cardioplegia in adult patients. It reduces the frequency of reperfusion, and shortens the clamping time. There is no additional injury in the important organs such as liver, kidney. Modified Del Nido cardioplegia myocardial protection ability in adult heart valve surgery is feasible.
Abstract： Objective To assess the effects of simultaneous antegrade/retrograde cardioplegia (SARC) on myocardial perfusion and energy metabolism in ischemic myocardium using magnetic resonance imaging (MRI). Methods After the hearts were harvested from 18 domestic pigs, left anterior descending artery, aorta, anterior ascending cardiac vein and coronary sinus were cannulated to establish the perfusion routes. 6 hearts were used to assess the effects of SARC on myocardial perfusion. Energy metabolism was observed in the other 12 pig hearts. MRI was used to monitor the distribution of contrast agent (gadoliniumdiethylenetriamine penlaacetic acid, Gd-DTPA) in the myocardium after its injection through arterial and retrograde perfusion routes. The efficacies in sustaining myocardial perfusion and energy metabolism were evaluated by using phosphorus-31 magnetic resonance spectroscopy (31P MRS) during antegrade cardioplegia (AC) and SARC respectively. Results It was found that injection of Gd-DTPA into the aorta during AC did not result in signal increase in the ischemic myocardium on MRI. During SARC, however, Gd-DTPA was found in the ischemic region as well as in the other regions, no matter if it was given into the aorta or into the coronary sinus. Moreover,31P spectra showed that occlusion of LAD during AC resulted in severe decrease of the levels of phosphocreatine (PCr) and adenosine triphosphate (ATP), while the level of inorganic phosphate (Pi) increased in LAD-support myocardium. The abnormal metabolic changes were completely abolished by use of SARC. Conclusion It is concluded that SARC can deliver cardioplegic solution to the myocardium distal to a coronary occlusion and can sustain normal energy metabolism in the jeopardized myocardium.
ObjectiveTo explore clinical outcomes of papaverine via the aortic root under cardiopulmonary bypass (CPB) in coronary artery bypass grafting. MethodsA total of 263 patients with coronary artery disease underwent CPB in coronary artery bypass grafting in Beijing Anzhen Hospital from August 2003 through December 2014 were included. According to whether or not they received papaverine perfusion via the aortic root in the first perfusion during CPB, all the 263 patients were divided into two groups including an intervention group and a control group. There were 176 patients in the intervention group including 109 males and 67 females with their average age of 64.37±23.54 years. They received aortic root perfusion of 60 mg papaverine diluted into 20 ml during the first perfusion, and repeated aspiration was performed 8 to 10 times in CPB when the heart beat weak. In the control group, there were 87 patients including 55 males and 32 females with their average age of 65.98±29.13 years. Patients in the control group received routine procedures of CPB except papaerine perfusion. Clinical effectiveness was compared between the two groups. ResultsThere was no in-hospital death. CPB supporting time after heart re-beating (9.58±3.21 min vs. 19.74±5.67 min, t=-1.133, P=0.000), dopamine usage 3.12±1.27 μg/(kg·min) vs. 4.98±2.53 μg/(kg·min),t=-0.913, P=0.031), epinephrine usage 0.018±0.009 μg/(kg·min) vs. 0.047±0.011 μg/(kg·min), t=-0.811, P=0.018) and nor epinephrine usage 0.021±0.011 μg/(kg·min) vs. 0.037±0.010 μg/(kg·min), t=-0.823, P=0.019) of the intervention group were significantly shorter or lower than those of the control group. Automatic heart re-beating rate of the intervention group was significantly higher than that of the control group (98.86% vs. 70.11%,t=-1.372, P=0.000). A total of 176 patients in the nitroglycerin group were followed up for 6-121 months, and 16 patients were lost during follow-up. During the follow-up period, 6 patients were hospitalized for cardiac events, and 2 died in 29 months and 103 months after surgery, and 9 died from cardiac events. ConclusionFor the patients undergoing on-pump coronary artery bypass grafting, some myocardial protection strategies including papaverine perfusion via the aortic root in the first perfusion, use of norepinephrine, and aortic root squeezing in high frequency by hand can significantly increase the automatic heart re-beating rate, shorten the CPB supporting time after heart re-beating, and improve postoperative clinical outcomes.