NORMOTHERMIC RETROGRADE CONTINUOUS CARDIOPLEGIA FOR MYOCARDIAL PROTECTION DURING CARDIOPULMONARY BYPASS - A MODIFIED TECHNIQUE

Normothermic retrograde continuous cardioplegia is a revolutionary dev elopment for myocardial preservation in cardiac surgery. Despite excel lent reports regarding this technique, the surgical community has expr essed concern over technical problems encountered. The method of normo thermic retrograde continuous cardioplegia in current use requires bot h large total crystalloid volumes and large potassium loads to deliver adequate cardioplegia. We have developed a technique that eliminates these problems. The heart is stopped by an initial infusion of normoth ermic cardioplegic solution through a coronary sinus catheter The infu sate is then converted to normothermic pump blood. Small boluses of po tassium chloride are added intermittently to maintain cardiac arrest. We applied this technique to 35 patients undergoing cardiac valve surg ery The average volume of crystalloid cardioplegia required was 125 mL (range, 40 to 155 mL), and the average total potassium load was 52 mE q (range, 2 to 100 mEq). Clinically significant sequelae were noted in 4 patients (11%), and 1 (3%) died of pneumonia on the 28th postoperat ive day The method we describe is a safe and effective alternative to the current technique of normothermic retrograde continuous cardiopleg ia and offers both physiologic and technical advantages to patients un dergoing cardiac valve procedures.