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Antegrade Cardioplegia for Surgery of the Aortic Root Appears Unnecessary
Dustin Hang, B.A.1, Alan Markowitz, M.D.2.
1Case Western Reserve University School of Medicine, Cleveland, OH, USA, 2University Hospitals, Cleveland, OH, USA.

Background: Administration of antegrade cardioplegia (ACP) is cumbersome in the open aortic root. In a series of almost 2,000 aortic valve procedures since 2000, retrograde cardioplegia (RCP) exclusively was used in the setting of severe aortic regurgitation or severely diseased ascending aortas with no effort made to cannulate the coronary ostia.
Methods: Retrospective study of 271 patients undergoing stentless aortic valve replacement or root replacement + ascending aortic/arch; 70 were excluded due to patent mammary grafts or addition of SVG's through which ACP was administered. Of 201 patients with RCP only, 27% were redo's, AVR-74; Root replacement-44; Root and ascending aorta/hemi or full arch-83. Cross-clamp (XCL) times were divided into three groups: < 90(XCI-1); 91-150(XCI-2); >150(XCI-3). Chi-square analysis was used for univariate analysis of categorical variables and ANOVA for continuous variables.




P value
XCL TIME (min)74 ± 9123 ± 16182 ± 300.00
CPB (min)112 ± 28163 ± 30236 ± 480.00
Table 1. Continuous variables as mean ± st. dev., XCL=cross clamp, CPB=cardiopulmonary bypass, MORT=mortality, CVA=cerebrovascular accident
Results: Overall mortality was 3.5%; mortality was 3.64% for redo's and 3.42% for virgin operations (p=0.94). 1 LVAD was placed for profound LV dysfunction due to unrecognized cold agglutinins; and 5 IAB's were employed (3 pre-op).
Conclusions: The success of myocardial preservation during open aortic procedures, as reflected by survival and complication rates, with RCP alone compares favorably with ACP only or ACP/RCP combination. In the literature, mortality ranges from 6.7-13.3% for aortic root replacement, 4.8% for aortic root+ascending aorta; mortality for reoperative aortic root replacement after previous aortic root procedures was reported at 11.5%, and 12% for reoperations on the aortic root/ascending aorta for aneurysm, false aneurysm, or infectious disease. The extra effort required to administer ACP appears unnecessary.
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