scholarly journals In Through the Out Door: Tips and Tricks for Giving Retrograde Cardioplegia

2018 ◽  
Vol 21 (4) ◽  
pp. E311-E317
Author(s):  
Stephen Derryberry ◽  
Curt Tribble
Keyword(s):  
Aortic Root ◽  
Tips And Tricks ◽  
Retrograde Cardioplegia ◽  
Delivery Route ◽  
Antegrade Cardioplegia ◽  
Coronary Ostia

Antegrade cardioplegia delivery is the most commonly used delivery route. It is given into the aortic root or directly into the coronary ostia. However, there are many reasons to consider using the retrograde delivery of cardioplegia. This treatise will review the background and techniques for delivering retrograde cardioplegia.

Comparative study between antegrade cardioplegia and retrograde cardioplegia using intraoperative myocardial contrast echography

1986 ◽  
pp. 235-239 ◽  
Author(s):  
S. Mihaileanu ◽  
J. N. Fabiani ◽  
J. Julien ◽  
J. Viossat ◽  
G. Dreyfus ◽  
...  
Keyword(s):  
Comparative Study ◽  
Retrograde Cardioplegia ◽  
Antegrade Cardioplegia

scholarly journals Transcatheter aortic root replacement with chimney grafts for coronary perfusion: a preliminary test in a three-dimensional-printed root model

2020 ◽  
Vol 31 (1) ◽  
pp. 121-128 ◽  
Author(s):  
Enrico Ferrari ◽  
Martin Scoglio ◽  
Giulia Piazza ◽  
Francesco Maisano ◽  
Ludwig Karl von Segesser ◽  
...  
Keyword(s):  
Aortic Root ◽  
Free Flow ◽  
Coronary Perfusion ◽  
Repair System ◽  
3 Dimensional ◽  
Root Repair ◽  
Root Model ◽  
Coronary Ostia ◽  
The Right ◽  
Aortic Root Repair

Abstract OBJECTIVES Transcatheter aortic root repair is still not available because of the technical challenge of coronary perfusion. The use of chimney grafts for coronary ostia can be an option and we tested the flow-through coronary chimney grafts deployed in a 3-dimensional-printed root model as part of a transcatheter aortic root repair system. METHODS A 3-dimensional-printed root was used to test the coronary flow after the deployment of 1 root endograft (28 mm diameter) and two 6-mm diameter 10-cm long coronary chimney grafts. Continuous coronary flows were measured in a bench test at different pressure levels (60, 80 and 100 mmHg) and compared to target coronary flows (250 ml/min at rest for the left and 150 ml/min at rest for the right coronary artery). RESULTS The computed tomography scan-based root was modified with two 5-mm diameter coronary conduits to overcome the limits of the original 3-dimensional-printed coronary ostia. The root was placed in the hydrodynamic system: adjusted coronary free flow at 60, 80 and 100 mmHg of pressure was 1913, 2200 and 2480 ml/min for left coronary and 1633, 2026 and 2366 ml/min for right coronary, respectively. After endografts deployment, mean chimney graft flow at 60, 80 and 100 mmHg of pressure was 1053 ml/min (−45%), 1306 ml/min (−41%) and 1502 ml/min (−40%) for the left coronary and 1100 ml/min (−33%), 1460 ml/min (−28%) and 1626 ml/min (−31%) for the right coronary, respectively. CONCLUSIONS In this preliminary study, chimney grafts for transcatheter aortic root repair provided 830% of target flow in the right coronary (−31% of free flow) and 414% of target flow in the left coronary (−42% of free flow) which is more than sufficient for both coronaries in real-life conditions. The potential of this approach should be further explored with specifically designed endografts.

Monitoring aortic root effluent during retrograde cardioplegia delivery

Perfusion ◽  
1997 ◽  
Vol 12 (5) ◽  
pp. 317-323 ◽  
Author(s):  
Patrick C Mannebach ◽  
Joseph J Sistino
Keyword(s):  
Aortic Root ◽  
Retrograde Cardioplegia

Coronary Ostial Anastomosis in Aortic Root Replacement

1996 ◽  
Vol 4 (1) ◽  
pp. 40-42
Author(s):  
Pasala S Ravichandran ◽  
H Storm Floten ◽  
Anthony P Furnary ◽  
Hugh L Gately ◽  
Hagop Hovaguimian ◽  
...  
Keyword(s):  
Aortic Root ◽  
Aortic Root Replacement ◽  
Secure Attachment ◽  
Coronary Ostia ◽  
Reliable Methods

We describe reliable methods for coronary ostial anastomosis in aortic root replacement which are uncomplicated and provide a secure attachment of the coronary ostia.

Does Cardioplegia Type Affect Outcome and Survival in Patients With Advanced Left Ventricular Dysfunction?

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Joseph E. Flack ◽  
James R. Cook ◽  
Susanne J. May ◽  
Stanley Lemeshow ◽  
Richard M. Engelman ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Solution Temperature ◽  
Blood Cardioplegia ◽  
Late Death ◽  
Retrograde Cardioplegia ◽  
Significant Difference ◽  
Cold Blood ◽  
Antegrade Cardioplegia

Background —There is controversy regarding which cardioplegic solution, temperature, and route of administration provides superior protection. The CABG Patch Trial enrolled a high-risk group of coronary artery disease patients with an ejection fraction of <36%. Thus, they constitute an ideal group to benefit most from optimal cardioplegic protection. Methods and Results —All patients randomized into the trial were compared with respect to the use of blood and crystalloid cardioplegia. In addition, a questionnaire was sent to surgeons requesting blood cardioplegic temperature and route. Patients receiving crystalloid cardioplegia versus those receiving blood cardioplegia were found to have significantly more operative deaths (2% versus 0.3%, P =0.02), postoperative myocardial infarctions (10% versus 2%, P <0.001), shock (13% versus 7%, P =0.013), and postoperative conduction defects (21.6% versus 12.4%, P =0.001). Despite this, early death (6% crystalloid versus 4% blood cardioplegia) and late death (24% crystalloid versus 21% blood cardioplegia) statistics were not significantly different. Patients receiving normothermic blood had less postoperative right ventricular dysfunction (10%) than did patients receiving cold blood (25%) or cold blood with warm reperfusion (30%) ( P =0.004). There was no significant difference in early or late death. Finally, patients who received combined antegrade and retrograde cardioplegia had significantly less inotrope use (71% versus 84%, P =0.002), right ventricular dysfunction (23% versus 41%, P =0.001), and postoperative balloon pump use (12% versus 19%, P =0.02) than did those who received antegrade cardioplegia. There was no difference in survival. Conclusions —Blood cardioplegia and combined antegrade and retrograde cardioplegia are superior to crystalloid and antegrade cardioplegia alone for postoperative morbidity. Despite this, there is no significant difference in early or late survival.

scholarly journals A case report of aortic root repair using a pericardial autograft for type A aortic dissection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yi Chang ◽  
Hongwei Guo ◽  
Xiangyang Qian ◽  
Fang Fang
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Aortic Wall ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Intimal Flap ◽  
Root Repair ◽  
Coronary Ostia

Abstract Background Acute type A aortic dissection with a dissection flap extending into the sinus segment often involves the commissures and the coronary ostia. In most cases, the intimal flap must be retained in order to restore aortic valve competence and reconstruct the coronary ostia. Residual dissection flap has the potential risks of proximal bleeding and adverse effects on long-term durability. We established a novel technique to reconstruct the aortic root using a pericardial autograft and significantly reduce remnant dissection tissues. Case presentation A 50-year-old female was admitted to our center with acute anterior chest pain and backache lasting about 10 h. Computed tomographic (CT) scans showed type A aortic dissection, with both coronary ostia being involved. Doppler echocardiography showed moderate aortic insufficiency. The dissection intimal flap was removed to the normal aorta wall near the annulus at the noncoronary sinus, leaving a 5 mm rim of intimal flap near the commissures and coronary ostia. Using a pericardial patch as a new aortic wall to reconstruct the root while preserving the aortic adventitia to fix and strengthen the new pericardial aortic wall. Ascending aorta and total arch replacement combined with frozen elephant trunk procedure was performed at the same time. The patient got an uneventful postoperative course. Conclusion Aortic root repair with a pericardial autograft is a safe and effective technique to treat acute type A dissection involving the sinus. Using this technique, residual dissection tissues could be significantly reduced, which subsequently decreases the risk of proximal bleeding and hence increases long-term durability.

scholarly journals P218 Accuracy and reproducibility of aortic root assessment by eSie Valves in patients candidate to transcatheter aortic valve implantation: a comparative study with computed tomography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Granata ◽  
A Veltri ◽  
S Iuliano ◽  
V Romano ◽  
S Stella ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Aortic Root ◽  
3D Model ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Coronary Ostia ◽  
Valve Implantation

Abstract Background Accurate imaging assessment of the aortic root (AR) is critical for prosthesis sizing in transcatheter aortic valve implantation. Multislice computed tomography (MSCT) is the gold standard for this purpose. 3D transesophageal (3D-TOE) reconstruction tools have recently been introduced, which automatically configures a geometric model of AR from 3D-TOE dataset and perform quantitative analyses of the AR. Purpose The aim of the study was to compare semi-automated measurements of AR obtained by eSie Valves (EV) (Siemens Medical Solution, California, USA) tool with MSCT. Methods We prospectively enrolled 26 consecutive patients (mean age 79.5 ± 7.5 years; 38% men) with severe symptomatic aortic stenosis (mean gradient 48.8± 13.6 mmHg) who underwent both 3D-TOE and MSCT as part of TAVI evaluation protocol. Volumetric datasets of the AR, acquired with 3D-TOE in mid-esophageal view, were analyzed with EV tool. EV tool automatically detected AR landmarks and, after user validation, created 3D model of AR providing values of area, perimeter, diameters of aortic annulus (AA) and coronary ostia heights (Fig 1). Results EV tool analysis on 3D-TOE volumetric data sets was feasible in all patients. Strong correlation between EV tool and MSCT assessment for AA major diameter (r = 0.79), AA minor diameter (r = 0.81), AA perimeter (r = 0.89) and AA area (r = 0.89) (all p&lt; 0.0001) was found. On average EV tool underestimated MSCT measurements of AA major diameter (1.2 mm, 4.5%), AA minor diameter (2.6 mm, 11.3%), AA perimeter (4 mm, 5.2%) and AA area (65.3 mmq, 13.6%). Moderate correlation between the two methods, already in this initial sample, for right coronary artery ostium height (r = 0.53, p = 0.007) was discovered. Finally, weak correlation for left coronary artery ostium height (r = 0.33, p = 0.1) was revealed. EV tool measurements from two different volumetric datasets of the same patient showed an excellent reproducibility intraclass correlation coefficient (ICC) for AA area 0.94 and ICC for right coronary height 0.98. Conclusion With these initial results EV tool could be used in clinical practice for quick and reliable assessment of AA area, perimeter and diameters. A larger group of patients will be needed to assess the consistency of coronary ostia height evaluation by EV tool. Abstract P218 Figure. eSie Valve landmarks and 3D model of AR

Sign in / Sign up

Export Citation Format

Share Document