Myocardial perfusion during warm antegrade and retrograde cardioplegia: A contrast echo study

Michael A. Borger, Kevin Wei, Richard D. Weisel, John S. Ikonomidis, Vivek Rao, Gideon Cohen, Toshizumi Shirai, Ahmad S. Omran, Samuel C. Siu, Harry Rakowski

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background. We evaluated distribution of warm antegrade and retrograde cardioplegia in patients undergoing coronary artery bypass grafting (CABG). Methods. Myocardial perfusion was evaluated pre- and post-CABG using transesophageal echocardiography with injection of sonicated albumin microbubbles (Albunex) during warm antegrade and retrograde cardioplegia. The left ventricle (LV) was evaluated in five segments and the right ventricle (RV) was evaluated in two segments. Segmental contrast enhancement was graded as absent (score = 0), suboptimal or weak (score = 1), optimal or excellent (score = 2), or excessive (score = 3). Results. Pre-CABG cardioplegic perfusion correlated weakly with severity of coronary artery stenoses (r = -0.331 and 0.276 for antegrade and retrograde cardioplegia, respectively). Antegrade cardioplegia administration resulted in 98% and 96% perfusion to the left ventricle pre- and post-CABG, respectively. Retrograde cardioplegic administration resulted in reduced LV perfusion. With 86% (p = 0.032 from antegrade) and 59% (p <0.001 from antegrade) pre- and post-CABG, respectively. The average LV perfusion score (mean ± SEM) was greater with antegrade than retrograde cardioplegia both pre-CABG (1.93 ± 0.04 vs 1.53 ± 0.11, p <0.001) and post-CABG (1.63 ±0.07 vs 1.19 ± 0:13, p = 0.004). RV perfusion was poor with both techniques pre-CABG, but improved significantly with antegrade cardioplegia post-CABG. Conclusions. We conclude that warm antegrade cardioplegia results in better left ventricular perfusion than warm retrograde cardioplegia. Right ventricular cardioplegic perfusion was suboptimal, but the best delivery was achieved with antegrade cardioplegia after coronary bypass. We therefore recommend construction of the saphenous vein graft to the right coronary artery early in the operative procedure.

Original languageEnglish (US)
Pages (from-to)955-961
Number of pages7
JournalAnnals of Thoracic Surgery
Volume68
Issue number3
DOIs
StatePublished - Sep 1999
Externally publishedYes

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Induced Heart Arrest
Coronary Artery Bypass
Perfusion
Heart Ventricles
Microbubbles
Coronary Stenosis
Transesophageal Echocardiography
Operative Surgical Procedures
Saphenous Vein
Albumins
Coronary Vessels
Transplants
Injections

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Myocardial perfusion during warm antegrade and retrograde cardioplegia : A contrast echo study. / Borger, Michael A.; Wei, Kevin; Weisel, Richard D.; Ikonomidis, John S.; Rao, Vivek; Cohen, Gideon; Shirai, Toshizumi; Omran, Ahmad S.; Siu, Samuel C.; Rakowski, Harry.

In: Annals of Thoracic Surgery, Vol. 68, No. 3, 09.1999, p. 955-961.

Research output: Contribution to journalArticle

Borger, MA, Wei, K, Weisel, RD, Ikonomidis, JS, Rao, V, Cohen, G, Shirai, T, Omran, AS, Siu, SC & Rakowski, H 1999, 'Myocardial perfusion during warm antegrade and retrograde cardioplegia: A contrast echo study', Annals of Thoracic Surgery, vol. 68, no. 3, pp. 955-961. https://doi.org/10.1016/S0003-4975(99)00797-3
Borger, Michael A. ; Wei, Kevin ; Weisel, Richard D. ; Ikonomidis, John S. ; Rao, Vivek ; Cohen, Gideon ; Shirai, Toshizumi ; Omran, Ahmad S. ; Siu, Samuel C. ; Rakowski, Harry. / Myocardial perfusion during warm antegrade and retrograde cardioplegia : A contrast echo study. In: Annals of Thoracic Surgery. 1999 ; Vol. 68, No. 3. pp. 955-961.
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abstract = "Background. We evaluated distribution of warm antegrade and retrograde cardioplegia in patients undergoing coronary artery bypass grafting (CABG). Methods. Myocardial perfusion was evaluated pre- and post-CABG using transesophageal echocardiography with injection of sonicated albumin microbubbles (Albunex) during warm antegrade and retrograde cardioplegia. The left ventricle (LV) was evaluated in five segments and the right ventricle (RV) was evaluated in two segments. Segmental contrast enhancement was graded as absent (score = 0), suboptimal or weak (score = 1), optimal or excellent (score = 2), or excessive (score = 3). Results. Pre-CABG cardioplegic perfusion correlated weakly with severity of coronary artery stenoses (r = -0.331 and 0.276 for antegrade and retrograde cardioplegia, respectively). Antegrade cardioplegia administration resulted in 98{\%} and 96{\%} perfusion to the left ventricle pre- and post-CABG, respectively. Retrograde cardioplegic administration resulted in reduced LV perfusion. With 86{\%} (p = 0.032 from antegrade) and 59{\%} (p <0.001 from antegrade) pre- and post-CABG, respectively. The average LV perfusion score (mean ± SEM) was greater with antegrade than retrograde cardioplegia both pre-CABG (1.93 ± 0.04 vs 1.53 ± 0.11, p <0.001) and post-CABG (1.63 ±0.07 vs 1.19 ± 0:13, p = 0.004). RV perfusion was poor with both techniques pre-CABG, but improved significantly with antegrade cardioplegia post-CABG. Conclusions. We conclude that warm antegrade cardioplegia results in better left ventricular perfusion than warm retrograde cardioplegia. Right ventricular cardioplegic perfusion was suboptimal, but the best delivery was achieved with antegrade cardioplegia after coronary bypass. We therefore recommend construction of the saphenous vein graft to the right coronary artery early in the operative procedure.",
author = "Borger, {Michael A.} and Kevin Wei and Weisel, {Richard D.} and Ikonomidis, {John S.} and Vivek Rao and Gideon Cohen and Toshizumi Shirai and Omran, {Ahmad S.} and Siu, {Samuel C.} and Harry Rakowski",
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T1 - Myocardial perfusion during warm antegrade and retrograde cardioplegia

T2 - A contrast echo study

AU - Borger, Michael A.

AU - Wei, Kevin

AU - Weisel, Richard D.

AU - Ikonomidis, John S.

AU - Rao, Vivek

AU - Cohen, Gideon

AU - Shirai, Toshizumi

AU - Omran, Ahmad S.

AU - Siu, Samuel C.

AU - Rakowski, Harry

PY - 1999/9

Y1 - 1999/9

N2 - Background. We evaluated distribution of warm antegrade and retrograde cardioplegia in patients undergoing coronary artery bypass grafting (CABG). Methods. Myocardial perfusion was evaluated pre- and post-CABG using transesophageal echocardiography with injection of sonicated albumin microbubbles (Albunex) during warm antegrade and retrograde cardioplegia. The left ventricle (LV) was evaluated in five segments and the right ventricle (RV) was evaluated in two segments. Segmental contrast enhancement was graded as absent (score = 0), suboptimal or weak (score = 1), optimal or excellent (score = 2), or excessive (score = 3). Results. Pre-CABG cardioplegic perfusion correlated weakly with severity of coronary artery stenoses (r = -0.331 and 0.276 for antegrade and retrograde cardioplegia, respectively). Antegrade cardioplegia administration resulted in 98% and 96% perfusion to the left ventricle pre- and post-CABG, respectively. Retrograde cardioplegic administration resulted in reduced LV perfusion. With 86% (p = 0.032 from antegrade) and 59% (p <0.001 from antegrade) pre- and post-CABG, respectively. The average LV perfusion score (mean ± SEM) was greater with antegrade than retrograde cardioplegia both pre-CABG (1.93 ± 0.04 vs 1.53 ± 0.11, p <0.001) and post-CABG (1.63 ±0.07 vs 1.19 ± 0:13, p = 0.004). RV perfusion was poor with both techniques pre-CABG, but improved significantly with antegrade cardioplegia post-CABG. Conclusions. We conclude that warm antegrade cardioplegia results in better left ventricular perfusion than warm retrograde cardioplegia. Right ventricular cardioplegic perfusion was suboptimal, but the best delivery was achieved with antegrade cardioplegia after coronary bypass. We therefore recommend construction of the saphenous vein graft to the right coronary artery early in the operative procedure.

AB - Background. We evaluated distribution of warm antegrade and retrograde cardioplegia in patients undergoing coronary artery bypass grafting (CABG). Methods. Myocardial perfusion was evaluated pre- and post-CABG using transesophageal echocardiography with injection of sonicated albumin microbubbles (Albunex) during warm antegrade and retrograde cardioplegia. The left ventricle (LV) was evaluated in five segments and the right ventricle (RV) was evaluated in two segments. Segmental contrast enhancement was graded as absent (score = 0), suboptimal or weak (score = 1), optimal or excellent (score = 2), or excessive (score = 3). Results. Pre-CABG cardioplegic perfusion correlated weakly with severity of coronary artery stenoses (r = -0.331 and 0.276 for antegrade and retrograde cardioplegia, respectively). Antegrade cardioplegia administration resulted in 98% and 96% perfusion to the left ventricle pre- and post-CABG, respectively. Retrograde cardioplegic administration resulted in reduced LV perfusion. With 86% (p = 0.032 from antegrade) and 59% (p <0.001 from antegrade) pre- and post-CABG, respectively. The average LV perfusion score (mean ± SEM) was greater with antegrade than retrograde cardioplegia both pre-CABG (1.93 ± 0.04 vs 1.53 ± 0.11, p <0.001) and post-CABG (1.63 ±0.07 vs 1.19 ± 0:13, p = 0.004). RV perfusion was poor with both techniques pre-CABG, but improved significantly with antegrade cardioplegia post-CABG. Conclusions. We conclude that warm antegrade cardioplegia results in better left ventricular perfusion than warm retrograde cardioplegia. Right ventricular cardioplegic perfusion was suboptimal, but the best delivery was achieved with antegrade cardioplegia after coronary bypass. We therefore recommend construction of the saphenous vein graft to the right coronary artery early in the operative procedure.

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