LeBoutillier M, Grossi E A, Steinberg B M, Baumann F G, Colvin S B, Spencer F C, Galloway A C
Department of Surgery, New York University Medical Center, NY 10016.
Circulation. 1994 Nov;90(5 Pt 2):II306-9.
Although retrograde warm continuous cardioplegia (RWCC) has been recently advocated as a method of myocardial preservation during cardiac surgery, scant data exist on the effects of RWCC on right ventricular function. However, previous data have clearly shown that retrograde cardioplegia is poorly distributed to the right ventricle and interventricular septum. This experiment was performed to analyze functional preservation of the right ventricle after RWCC.
Fourteen mongrel dogs were instrumented with sonomicrometers and pressure transducers to determine left and right ventricular (LV, RV) pressure-volume relationships and placed on cardiopulmonary bypass. All dogs underwent 90 minutes of aortic cross-clamping with either (1) RWCC (n = 7) after antegrade warm arrest or (2) retrograde cold multidose cardioplegia (RCMC) (n = 7) with topical hypothermia after antegrade cold arrest. All dogs received identical blood cardioplegia solutions. Ventricular function was measured before arrest and 30 and 60 minutes after unclamping. The end-diastolic-work area relationship was calculated, and the slope is presented as percent of baseline (mean +/- SEM; repeated measures ANOVA). At 30 minutes after unclamping, RWCC provided 68.77 +/- 9.09 for the left ventricle and 41.03 +/- 7.49 (P < .05 for RWCC versus RCMC for RV function at 30 minutes) for the right ventricle, and RCMC provided 62.80 +/- 7.23 for the left ventricle and 79.40 +/- 13.82 for the right ventricle. At 60 minutes after unclamping, RWCC provided 58.24 +/- 12.35 for the left ventricle and 48.05 +/- 9.72 for the right ventricle, and RCMC provided 65.38 +/- 6.76 for the left ventricle and 61.95 +/- 8.70 for the right ventricle. (P = NS for RWCC versus RCMC for LV function at either 30 or 60 minutes). These results demonstrate depressed recovery of RV function after 90 minutes of RWCC (P < .05 at 30 minutes after reperfusion) compared with RCMC. No difference in recovery of LV function was detected.
RWCC may be harmful to the right ventricle and should be used with caution, particularly in patients with preexisting RV hypertrophy.
尽管逆行温血持续心脏停搏（RWCC）最近被提倡作为心脏手术期间心肌保护的一种方法，但关于RWCC对右心室功能影响的数据却很少。然而，先前的数据清楚地表明，逆行心脏停搏液在右心室和室间隔的分布较差。本实验旨在分析RWCC后右心室的功能保护情况。
14只杂种犬植入超声微测仪和压力传感器，以确定左、右心室（LV、RV）的压力-容积关系，并进行体外循环。所有犬均经历90分钟的主动脉阻断，其中（1）7只犬在顺行温停搏后采用RWCC，（2）7只犬在顺行冷停搏后采用逆行冷多次剂量心脏停搏液（RCMC）并局部低温。所有犬均接受相同的血液心脏停搏液。在停搏前以及松开阻断钳后30分钟和60分钟测量心室功能。计算舒张末期功-面积关系，斜率以基线百分比表示（均值±标准误；重复测量方差分析）。松开阻断钳后30分钟，RWCC组左心室为68.77±9.09，右心室为41.03±7.49（RWCC组与RCMC组在30分钟时右心室功能比较，P<0.05）；RCMC组左心室为62.80±7.23，右心室为79.40±13.82。松开阻断钳后60分钟，RWCC组左心室为58.24±12.35，右心室为48.05±9.72；RCMC组左心室为65.38±6.76，右心室为61.95±8.70。（RWCC组与RCMC组在30分钟或60分钟时左心室功能比较，P=无显著性差异）。这些结果表明，与RCMC相比，RWCC 90分钟后右心室功能恢复较差（再灌注后30分钟时P<0.05）。未检测到左心室功能恢复的差异。
RWCC可能对右心室有害，应谨慎使用，尤其是在已有右心室肥厚的患者中。
