The Efficacy of Continuous Retrograde Cardioplegia for Mitral Annuloplasty in a Case with Total Obstruction at Both Orifices of the Native Coronary Arteries

Satoshi Sakakibara; Takashi Yamauchi; M. Nakae; Naosumi Sekiya; Teruya Nakamura

doi:10.4326/jjcvs.53.95

May 15, 2024Japanese Journal of Cardiovascular SurgeryOpen Access

The Efficacy of Continuous Retrograde Cardioplegia for Mitral Annuloplasty in a Case with Total Obstruction at Both Orifices of the Native Coronary Arteries

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Key result

Continuous retrograde cardioplegia provides adequate myocardial protection during mitral annuloplasty despite total coronary obstruction.

Why the study?

Myocardial protection during mitral annuloplasty is challenging in patients with total occlusion of both native coronary artery orifices, making conventional antegrade perfusion impossible.

Key Points

To assess the efficacy of continuous retrograde cardioplegia during mitral annuloplasty in a patient with total bilateral occlusion of the native coronary artery orifices.
Evaluated a 75-year-old male with worsening mitral regurgitation and prior coronary artery bypass grafting whose preoperative CT showed complete ostial obstruction of both native coronary arteries.
Performed continuous retrograde cardioplegia combined with surgical dissection and clamping of patent bilateral internal thoracic artery grafts to facilitate mitral annuloplasty.
Achieved a stable cardiac arrest time of 131 minutes with an optimal, virtually bloodless operative field.
Demonstrated effective myocardial preservation without acute ischemic complications, marked by a peak postoperative CK-MB of 50.5 IU/L.

Structured PICO

P

Population

1 75-year-old male with worsening mitral regurgitation, heart failure, and history of old myocardial infarction, prior PCI, and prior CABG, presenting with complete occlusion of bilateral native coronary orifices.

I

Intervention

Continuous retrograde cardioplegia during mitral annuloplasty

O

Outcome

Myocardial protection (assessed by cardiac arrest maintenance, surgical field visibility, and postoperative max CK-MB)surrogate

Continuous retrograde cardioplegia is an effective myocardial protection strategy during mitral valve surgery in patients with completely occluded native coronary orifices who are dependent on patent bypass grafts.

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Implication

Should not yet change cardioplegia practice; leaves open role of continuous retrograde delivery in total coronary obstruction.

Abstract

症例は75歳男性．陳旧性心筋梗塞に対し経皮的冠動脈形成術，16年前に冠動脈バイパス術（左内胸動脈-左前下行枝, 右内胸動脈-橈骨動脈-4PD-14PL）を施行され，以降外来フォローされていた．心不全症状，心エコーで僧帽弁閉鎖不全症の増悪を認め，手術目的に当科入院となった．術前冠動脈CTでnative coronary arteryはorificeからgraft吻合部近位まで両側とも完全閉塞，冠血流は上記graftのみに完全依存していた．そのため手術時心筋保護は順行性冠灌流法が不可能であった．術中両側ITAのgraft剥離，遮断が可能だったため，逆行性持続冠灌流法を用いて手術を施行した．術中心停止は131分，心停止維持ならびに術野もほぼ無血視野で良好であり，術後max CK-MBは50.5 IU/Lと心筋保護も十分であると思われた．

Discussion

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Cite This Study

Sakakibara et al. (2024) studied this question. Continuous retrograde cardioplegia provided adequate myocardial protection (max CK-MB 50.5 IU/L) during mitral annuloplasty in a case with total obstruction of both native coronary arteries.

synapsesocial.com/papers/6ab0ba9a06235d720047833b https://doi.org/10.4326/jjcvs.53.95

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The Efficacy of Continuous Retrograde Cardioplegia for Mitral Annuloplasty in a Case with Total Obstruction at Both Orifices of the Native Coronary Arteries

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Efficacy of Continuous Retrograde Cardioplegia for Mitral Annuloplasty in a Case with Total Obstruction at Both Orifices of the Native Coronary Arteries

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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