COMPLEX VALVE OPERATIONS - ANTEGRADE VERSUS RETROGRADE CARDIOPLEGIA

Background. Increasingly complex cardiac procedures demand optimal myo cardial protective techniques during the requisite interval of aortic cross-clamping. I;or complex procedures in which prolonged cross-clamp times are anticipated, we favor combined antegrade and retrograde fol d blood cardioplegia. Advantages include rapid arrest, uniform distrib ution, and an uninterrupted operation. Methods. We retrospectively eva luated the cases of 194 consecutive patients who underwent complex car diovascular procedures between January 1988 and October 1994. Procedur es performed included valve repair and coronary artery bypass grafting (23.7%), valve replacement and coronary artery bypass grafting (19.1% ), complex aortic arch and valve procedures (16.6%), valve repair only (16.5%), reoperative valve (9.8%), and multiple-valve replacements (9 .3%). Cardioplegic arrest times averaged 113 +/- 38.5 minutes (range, 52 to 292 minutes), Results. Postoperative left and right ventricular function was evaluated using transesophageal echocardiography. The ech ocardiograms revealed a 3.1% incidence of new left ventricular dysfunc tion and no case of right ventricular dysfunction. Of the patients eva luated, 75.7% required little (<3 mu g.kg(-1).min(-1) of dopamine hydr ochloride) or no inotropic support postoperatively. The 30-day mortali ty rate was 3.1%, and no death was due to cardiac failure. Conclusions . We conclude that myocardial protection using a combined antegrade an d retrograde cardioplegia technique permits excellent myocardial prote ction during complex cardiovascular procedures requiring long arrest t imes.