Transesophageal Echocardiography Guidance of Antegrade Cardioplegia Delivery for Cardiac Surgery

David J. Canty, Prashant Joshi, Colin F. Royse, James McMillan, Sara Tayeh, Julian A. Smith

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives The initial volume of antegrade cardioplegia used to induce asystole during aortic cross-clamp still is based on empiric methods and may be excessive, potentially leading to hyperkalemia, myocardial edema, and acute left ventricular distention from aortic regurgitation. The objectives were to determine whether the volume of cardioplegia required to induce asystole is proportional to left ventricular mass, and whether the degree of left ventricular distention is proportional to the severity of aortic regurgitation. Design Prospective observational study. Setting Two tertiary university hospitals. Interventions Transesophageal echocardiography was used to estimate left ventricular mass (prolate ellipse revolution formula), quantify aortic regurgitation, and monitor for distention during initial antegrade cardioplegia delivery. The volume of cardioplegia required for asystole was recorded. Participants Fifty-eight patients aged over 18 years scheduled for cardiac surgery requiring aortic cross-clamping. Measurements and Main Results There was a weak correlation of left ventricular mass and antegrade cardioplegia volume required for asystole (r = 0.35, p = 0.047). The degree of left ventricular distention correlated moderately with the severity of aortic regurgitation (r = 0.55, p = 0.007) and was excessive and stopped early (aborted) in 24% of all patients, including 18% of 39 patients without aortic regurgitation. An aortic regurgitation vena contracta of 0.3 cm predicted aborted cardioplegia with modest accuracy (AUC 0.81, 0.66-0.99, p = 0.02, sensitivity 71%, specifity 81%). Conclusions Estimated left ventricular mass is not a useful predictor of the initial volume of antegrade cardioplegia required to induce asystole. However transesophageal echocardiography can predict and monitor for left ventricular distention, which is common.

Original languageEnglish
Pages (from-to)1498-1503
Number of pages6
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume29
Issue number6
DOIs
Publication statusPublished - 1 Dec 2015
Externally publishedYes

Keywords

  • aortic valve insufficiency
  • cardiac arrest
  • cardiac surgery
  • cardioplegia
  • transesophageal echocardiography

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