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1993, Annals of Thoracic Surgery
The Annals of Thoracic Surgery
Is Warm Retrograde Blood Cardioplegia Better Than Cold for Myocardial Protection?1997 •
The Annals of Thoracic Surgery
Myocardial protection for coronary bypass grafting: The Toronto Hospital perspective1995 •
The Journal of Thoracic and Cardiovascular Surgery
The regional capillary distribution of retrograde blood cardioplegia in explanted human hearts1995 •
The Annals of Thoracic Surgery
Retrograde continuous warm blood cardioplegia1992 •
This report presents the results in our first clinical series of patients receiving continuous warm blood cardioplegia through the coronary sinus. Warm oxygenated blood cardioplegia has certain theoretical advantages, such as continuously supplying oxygen and substrates to the arrested heart while avoiding the side effects of hypothermia. Retrograde infusion of cardioplegia also offers certain advantages (eg, in valve operations and in patients with severe coronary artery disease) that are complementary to warm blood cardioplegia. Retrograde warm blood cardioplegia was used in 113 consecutive patients (85 men and 28 women with a mean age of 61 years) undergoing various procedures. Three percent of the patients died, 7% needed transient intraaortic balloon pump support, 6% had evidence of perioperative myocardial infarction, and 96% had spontaneous return of rhythm. There were no coronary sinus injuries. This new technique of retrograde continuous warm blood cardioplegia is a simple, safe, and reliable method of myocardial protection that may change the way we currently protect the heart intraoperatively.
The Annals of Thoracic Surgery
Retrograde continuous warm blood cardioplegia: a new concept in myocardial protection1991 •
The Annals of Thoracic Surgery
Prospective, randomized trial of retrograde warm blood cardioplegia: Myocardial benefit and neurologic threat1994 •
From March 1991 through July 1992, 1,001 patients having elective coronary artery bypass grafting were randomized to receive either continuous warm (> or = 35 degrees C) blood cardioplegia with systemic normothermia (> or = 35 degrees C) or intermittent cold (< or = 8 degrees C) oxygenated crystalloid cardioplegia and moderate systemic hypothermia (< or = 28 degrees C). Preoperative variables including age, sex, prior coronary bypass grafting, hypertension, prior myocardial infarction, diabetes, angina class, and preoperative heart failure class were similar in both groups, as were the intraoperative variables of number of coronary grafts, mammary artery use, and cardiopulmonary bypass time. Aortic cross-clamp time was significantly longer in the warm group (46 +/- 23 minutes versus 40 +/- 21 minutes). Most postoperative variables including mortality (warm, 1.0%, and cold, 1.6%), Q wave infarction (warm, 1.4%, and cold, 0.8%), and need of an intraaortic balloon pump (warm, 1.4%, and cold, 2.0%) were similar between groups. Total neurologic events (warm, 4.5%, and cold, 1.4%; p < 0.005) and perioperative strokes (warm, 3.1%, and cold, 1.0%; p < or = 0.02) were significantly higher in the warm group. Neurologic events included perioperative stroke (warm, 15 patients, and cold, 5 patients; p < 0.02), perioperative encephalopathy (warm, 2 patients, and cold, 1 patient), and delayed (> or = 3 in-hospital days) stroke (warm, 5 patients, and cold, 1 patient). All patients experiencing a stroke had a persistent neurologic deficit at the time of discharge. Encephalopathy resolved completely in all instances.(ABSTRACT TRUNCATED AT 250 WORDS)
International Journal of Angiology
Continuous warm blood cardioplegia: A randomized prospective clinical comparison1996 •
Seventy-eight patients undergoing isolated coronary artery bypass grafting (CABG) were randomized to receive one of two myocardial preservation techniques. Control patients (C) (n=38) had myocardial protection by moderate systemic hypothermia, topical cold saline, and myocardial arrest with antegrade dilute blood/cold potassium cardioplegia with subsequent intermittent retrograde solution every 10–15 minutes during the period of aortic cross-clamping. The experimental group (warm blood, WB) (n=40) had myocardial protection at systemic normothermia, myocardial arrest with antegrade high potassium, and warm blood cardioplegia with subsequent continuous retrograde low potassium warm blood cardioplegia throughout aortic cross-clamping. The two groups were similar preoperatively. After aortic declamping, all WB patients developed a spontaneous rhythm. Only three (7.5%) required intraoperative defibrillation compared with 23 (61%) C patients,p<0.0001. The cross-clamp time per graft was greater with WB,p=0.003. The postoperative need for inotropes, cardiac pacing, incidence of ventricular dysrhythmia, chest tube drainage, and hospital stay did not differ between groups. Perioperative myocardial infarction occurred in 2 WB and 0 C patients (p=0.25). Mortality was not different between groups (WB=1, C=2,p=0.89). It is possible to perform CABG with continuous warm blood cardioplegia with low morbidity and mortality. However, no clear advantage was demonstrated over standard techniques that allow the technical ease of a bloodless field. The metabolic and physiologic significance of spontaneous resumption of sinus rhythm upon aortic declamping remains to be elucidated.
The Annals of Thoracic Surgery
Anatomic and hemodynamic considerations influencing the efficiency of retrograde cardioplegia2001 •
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European Journal of Cardio-Thoracic Surgery
Myocardial protection in adult cardiac surgery: current options and future challenges2003 •
2010 •
The Annals of Thoracic Surgery
Intermittent Antegrade Tepid Versus Cold Blood Cardioplegia in Elective Myocardial Revascularization1998 •
The Annals of Thoracic Surgery
Postischemic deterioration of sarcoplasmic reticulum: Warm versus cold blood cardioplegia1993 •
Annals of Thoracic Surgery
Warm heart surgery and results of operation for recent myocardial infarction1991 •
Annals of Thoracic Surgery
Retrograde Coronary Sinus Perfusion for Myocardial Protection during Cardiopulmonary Bypass1978 •
The Journal of Thoracic and Cardiovascular Surgery
Does antegrade blood cardioplegia alone provide adequate myocardial protection in patients with left main stem disease?2003 •
1995 •
The Annals of Thoracic Surgery
A randomized study of the systemic effects of warm heart surgery1992 •
The Journal of Thoracic and Cardiovascular Surgery
Antegrade and retrograde cardioplegia: Alternate or simultaneous?1996 •
Annals of Thoracic Surgery
Retrograde Coronary Perfusion: Effects on Iatrogenic Edema and Diastolic Properties1998 •
The Journal of Thoracic and Cardiovascular Surgery
Risk factors of incomplete distribution of cardioplegic solution during coronary artery grafting1995 •
Annals of Thoracic Surgery
Myocardial Distribution of Antegrade Cold Crystalloid and Tepid Blood Cardioplegia1998 •
The Annals of Thoracic Surgery
Myocardial Protection During Open-Heart Surgery: Coronary Perfusion Versus Topical Cardiac Hypothermia1970 •
The Journal of Thoracic and Cardiovascular Surgery
Adequate distribution of warm cardioplegic solution1995 •
Journal of Cardiac Surgery
Warm Heart Surgery: Reflections on the History of its Development2007 •
The Journal of Thoracic and Cardiovascular Surgery
Coronary sinus ostial occlusion during retrograde delivery of cardioplegic solution significantly improves cardioplegic distribution and efficacy1995 •
The Annals of Thoracic Surgery
Does Normothermic Normokalemic Simultaneous Antegrade/Retrograde Perfusion Improve Myocardial Oxygenation and Energy Metabolism for Hypertrophied Hearts?2007 •
Heart (British Cardiac Society)
Reduction of oxidative stress does not affect recovery of myocardial function: warm continuous versus cold intermittent blood cardioplegia1997 •
Revista Brasileira de Cirurgia Cardiovascular
Clinical and ultramicroscopic myocardial randomized study of beating versus arrested heart for mitral surgeryCardiovascular Surgery
Experience with warm blood cardioplegia in 480 patients1995 •
Annals of Thoracic Surgery
Limitation of vasodilation associated with warm heart operation by a “mini-cardioplegia” delivery technique1993 •
Journal of Cardiac Surgery
Surgery for Cardiac Valves and Aortic Root Without Cardioplegic Arrest ("Beating Heart"): Experience with a New Method of Myocardial Perfusion2007 •
The Annals of Thoracic Surgery
Neonatal myocardial oxygen consumption during ventricular fibrillation, hypothermia, and potassium arrest1996 •
Indian Journal of Thoracic and Cardiovascular Surgery
Comparison of isothermic and cold cardioplegia in paediatric cardiac surgery2007 •
The Annals of Thoracic Surgery
Efficacy of myocardial protection with hypothermic blood cardioplegia depends on oxygen1991 •
The Journal of Heart and Lung Transplantation
A cardioprotective preservation strategy employing ex vivo heart perfusion facilitates successful transplant of donor hearts after cardiocirculatory death2013 •
Journal of Cardiac Surgery
On-Pump Beating Heart Versus Hypothermic Arrested Heart Valve Replacement Surgery2008 •
Journal of Cardiothoracic and Vascular Anesthesia - J CARDIOTHORAC VASC ANESTH
Normothermic cardiopulmonary bypass1997 •
1994 •
Annals of Thoracic Surgery
Improved recovery of immature myocardium with l-glutamate blood cardioplegia1993 •
The Annals of Thoracic Surgery
Beneficial effects of ischemic preconditioning on right ventricular function after coronary artery bypass grafting2000 •
Journal of Cardiothoracic and Vascular Anesthesia
Comparison of perioperative myocardial protection with nifedipine versus nifedipine and metoprolol in patients undergoing elective coronary artery bypass grafting1996 •
The Annals of Thoracic Surgery
Warm heart surgery: Experience with long cross-clamp times1991 •
2010 •
Journal of Cardiac Surgery
Assessment of Right Ventricular Function Postretrograde Cardioplegia by Transesophageal Echocardiography1998 •
Journal of Cardiothoracic and Vascular Anesthesia
Pro: Hypothermic Cardiopulmonary Bypass Should Be Used Routinely2012 •
The Annals of Thoracic Surgery
Superiority of retrograde cardioplegia after acute coronary occlusion☆1991 •