Recent Developments in Myocardial Protection: Retrograde Cardioplegia

Abstract

In recent years there has been increasing use of coronary sinus perfusion to deliver cardioplegic solutions during open-heart surgery. This has been aided by advances in coronary sinus catheter design and by easier methods of cannula insertion. Coronary sinus perfusion has been used with both intermittent crystalloid and blood cardioplegia and has recently evolved to include retrograde continuous normothermic blood cardioplegia. Coronary sinus perfusion has several advantages including safety, ease of use (with a single cannula placed out of the operative field), usefulness in patients with significant aortic regurgitation, redo coronary artery bypass graft surgery, and acute myocardial infarction. However, there are continuing concerns about the distribution of retrograde perfusion, preservation of right ventricular function, dislodgment of the coronary sinus catheter (and resulting ischemia during surgery), and damage to the coronary sinus.