Experimental study of myocardial preservation in open heart surgery: retrograde coronary sinus perfusion
Nieda, S.
Nihon Kyobu Geka Gakkai 28(3): 399-407
1980
ISSN/ISBN: 0369-4739 PMID: 7381261 Document Number: 163825
Several methods of myocardial preservation were evaluated experimentally during anoxic crossclamping for 60 min. Adult, mongrel dogs (48) weighing 20-38 kg were anesthetized with i.v. pentobarbital sodium and ventilation was provided with a Harvard volume respirator through a cuffed endotracheal tube. Bilateral transsternal thoracotomy was performed. The cannulations and extracorporeal circuit were used for total cardiopulmonary bypass and estimation of cardiac function. Experimental dogs were divided into 6 groups according to the methods of myocardial protection: I, control; II, anoxic arrest; III, intermittent coronary perfusion; IV, topical cooling; V, retrograde coronary sinus perfusion (RCSP) without hydrocortisone; VI, RCSP with hydrocortisone. In RCSP, the Foley catheters were inserted into the coronary sinus through the right atrium. The balloons were inflated to prevent backflow. The retrograde coronary circulation was performed by gravity drainage. Distance from the infusion bottle to the heart was usually held at 60 cm. The infusion bottle was transferred from arterial limb at the heart-lung machine. Retrograde coronary perfusate was cooled using a Brawn-Harrison heat exchanger at a temperature of 4.degree. C. In group VI, hydrocortisone 20 mg/kg and lidocaine 1 mg/kg were injected into an infusion bottle after .apprx. 45 min of aortic crossclamping. The best myocardial protection of 6 experimental groups was accomplished in group I and group VI. The ischemic heart of group demonstrated naturally the worst result. Regarding rapid and homogenous cooling of myocardium coronary perfusion using cold perfusate in RCSP is a better method than the topical cooling alone. RCSP with the use of hydrocortisone is a useful alternative of myocardial protection during aortic crossclamping. RCSP provides an excellent operative field during open heart operation, particulary in valvular diseases involving the aortic valve.