Thorac Cardiovasc Surg 2007; 55(4): 259-261
DOI: 10.1055/s-2006-924572
Short Communications

© Georg Thieme Verlag KG Stuttgart · New York

A New Technique of Myocardial Protection during Aortic Root Replacement: Antegrade/Retrograde Coronary Perfusion

S. F. Katircioglu1 , F. Cicekcioglu1 , A. I. Parlar1 , U. Tutun1 , U. Mungan1 , A. Aksoyek1
  • 1Cardiovascular Surgery Clinic, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
Further Information

Publication History

Received March 31, 2006

Publication Date:
04 June 2007 (online)

Introduction

The conventional technique for aortic root surgery consists of cardiopulmonary bypass (CPB), aortic cross-clamping, systemic cooling and cardioplegic arrest of the heart [[1], [2]]. The whole operation is time consuming and exposes the heart to ischemic reperfusion injury after the removal of aortic cross-clamping. These factors become especially important in patients with impaired left ventricular function or with a calcified aneurysm partially occluding the coronary artery ostia. There is consensus among surgeons that the adverse and damaging effects of cardioplegic techniques are ischemia and reperfusion injury, especially in cases with longer cross-clamping times [[3]]. More recently, perfect results have been reported with warm, beating heart surgery [[4], [5]].

A case of aortic root replacement with the Cabrol technique performed for ascending aortic aneurysm on a beating heart, which was continuously perfused via the antegrade and retrograde routes with normothermic blood throughout the procedure, is presented here.

References

  • 1 Cabrol C, Pavie A, Mesnildrey P. et al . Long-term results with total replacement of the ascending aorta and reimplantation of the coronary arteries.  J Thorac Cardiovasc Surg. 1986;  91 17-25
  • 2 Kouchoukas N T, Wareing T H, Murphy S F. et al . Sixteen year experience with aortic root replacement: results of 172 operations.  Ann Thorac Surg. 1991;  214 308-320
  • 3 Weman S M, Karhunen P J, Penttila A, Jarviner A A, Salminen U S. Reperfusion injury associated with one-fourth of deaths after coronary artery bypass grafting.  Ann Thorac Surg. 2000;  70 807-812
  • 4 Matsumoto Y, Watanabe G, Endo M, Sasaki H, Kasahima F, Kosugi I. Efficacy and safety of on-pump beating heart surgery for valvular disease.  Ann Thorac Surg. 2002;  74 678-683
  • 5 Gersak B, Sutlic Z. Aortic and mitral valve surgery on the beating heart is lowering cardiopulmonary bypass and aortic cross clamp time.  Heart Surg Forum. 2002;  5 182-186
  • 6 Misare B D, Krukenkamp B D, Lazer Z P, Levitsky S L. Recovery of postischemic contractile function is depressed by antegrade warm continuous blood cardioplegia.  J Thorac Cardiovasc Surg. 1993;  105 37-44
  • 7 Mehlhorn U, Allen S J, Adamus D L, Davis K L, Gogola G R, Warters R D. Cardiac surgical conditions induced by β-blockade: effect on myocardial fluid balance.  Ann Thorac Surg. 1996;  62 143-150
  • 8 Katircioglu S F, Gokce P, Ulus A T, Tutun U, Koc B. Reduction of the infarcted area with the use of simplified coronary sinus retroperfusion during experimental coronary artery occlusion.  Int J Cardiol. 2000;  73 115-121
  • 9 Katircioglu S F, Iscan H Z, Ulus T, Saritas Z. Myocardial preservation in acute coronary artery occlusion with coronary sinus retroperfusion and carnitine.  J Cardiovasc Surg (Torino). 2000;  41 45-50
  • 10 Kaplon R J, Pham S M, Salerno T A. Beating heart valvular surgery: a possible alternative for patients with severely compromised ventricular function.  J Card Surg. 2002;  17 170-172

Ali Ihsan Parlar

Turkiye Yuksek Ihtisas Hospital
Cardiovascular Surgery Clinic

Kizilay Sokak

06100 Ankara

Turkey

Fax: + 90 31 22 29 58 68

Email: aliparlar20@yahoo.com