PMID- 9925074
OWN - NLM
STAT- MEDLINE
DCOM- 19990205
LR  - 20190514
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 115
IP  - 1
DP  - 1999 Jan
TI  - Can retrograde cardioplegia alone provide adequate protection for cardiac valve 
      surgery?
PG  - 135-9
AB  - BACKGROUND: When aortic insufficiency is present, antegrade delivery of 
      cardioplegia requires coronary cannulation. Use of retrograde cardioplegia 
      simplifies administration. The efficacy of the retrograde route alone in ensuring 
      adequate myocardial protection may be assessed by the clinical outcome. METHODS 
      AND RESULTS: We used closed transatrial coronary sinus perfusion as the sole 
      method of cardioplegia delivery in 100 patients who underwent valve operations, 
      either isolated or combined with coronary (n=24), ascending aortic aneurysm 
      (n=8), or other procedures. Eighty-one patients were in New York Heart 
      Association (NYHA) Class III or IV; 23 had undergone previous heart operations; 
      23 were admitted from the coronary care unit (CCU); and 20 had left ventricular 
      ejection fraction (LVEF) of < or = 40%. Operative mortality was 2%. An 
      intra-aortic balloon pump was required in eight patients. On univariate analysis, 
      perioperative use of inotropes (n=26) was related to age > or = 70 years 
      (p=0.02), COPD (p=0.05), pulmonary hypertension (p=0.005), higher NYHA Class 
      (p=0.0006), preoperative heart failure (p=0.006), lower LVEF (p=0.0003), urgency 
      (p=0.00001), admission from the CCU (p=0.006), repeat operation (p=0.03), 
      coronary artery disease (p=0.02), and longer ischemic (p=0.02) and bypass times 
      (p=0.0003). On multivariate stepwise logistic regression analysis, use of 
      inotropes was related to preoperative lower LVEF (p=0.02) and urgency of 
      operation (p=0.0002). Perioperative complications included ventricular arrhythmia 
      in six, heart block in one, renal dysfunction in nine, and stroke in two 
      patients; no patient had myocardial infarction. CONCLUSION: Good clinical results 
      can be obtained by using retrograde cardioplegia alone without prior doses of 
      antegrade cardioplegia in all valve operations.
FAU - Talwalkar, N G
AU  - Talwalkar NG
AD  - Division of Cardiothoracic Surgery, Baylor College of Medicine, Methodist 
      Hospital, Houston, TX 77030, USA.
FAU - Lawrie, G M
AU  - Lawrie GM
FAU - Earle, N
AU  - Earle N
FAU - DeBakey, M E
AU  - DeBakey ME
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Cardioplegic Solutions)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Aneurysm, Thoracic/surgery
MH  - Cardioplegic Solutions/administration & dosage
MH  - Combined Modality Therapy
MH  - Coronary Artery Bypass
MH  - Coronary Disease/surgery
MH  - Female
MH  - Heart Valve Diseases/*surgery
MH  - *Heart Valve Prosthesis Implantation
MH  - Humans
MH  - *Hypothermia, Induced
MH  - Male
MH  - Middle Aged
MH  - Myocardial Reperfusion Injury/etiology/*prevention & control
MH  - Postoperative Complications/etiology/prevention & control
MH  - Risk Factors
EDAT- 1999/01/30 00:00
MHDA- 1999/01/30 00:01
CRDT- 1999/01/30 00:00
PHST- 1999/01/30 00:00 [pubmed]
PHST- 1999/01/30 00:01 [medline]
PHST- 1999/01/30 00:00 [entrez]
AID - S0012-3692(15)38094-6 [pii]
AID - 10.1378/chest.115.1.135 [doi]
PST - ppublish
SO  - Chest. 1999 Jan;115(1):135-9. doi: 10.1378/chest.115.1.135.