Can retrograde cardioplegia alone provide adequate protection for cardiac valve surgery?

Background: When aortic insufficiency is present, antegrade delivery of cardioplegia requires coronary cannulation, Use of retrograde cardioplegia simplifies administration. The efficacy of the retrograde route alone in ensuring adequate myocardial protection may be assessed by the clinical outcome. Methods and results: We used closed transatrial coronary sinus perfusion as the sole method of cardioplegia delivery in 100 patients who underwent valve operations, either isolated or combined with coronary (n = 24), ascending aortic aneurysm (n = 8), or other procedures. Eighty-one patients were in New York Heart Association (NYHA) Class III or IV; 23 had undergone previous heart operations; 23 were admitted from the coronary care unit (CCU); and 20 had left ventricular ejection fraction (LVEF) of less than or equal to 40%. Operative mortality was 2%. An intra-aortic balloon pump was required in eight patients. On univariate analysis, perioperative use of inotropes (n = 26) was related to age greater than or equal to 70 years (p = 0.02), COPD (p = 0.05), pulmonary hypertension (p=0.005), higher NYHA Class (p=0.0006), preoperative heart failure (p = 0.006), lower LVEF (p = 0.0003), urgency (p = 0.00001), admission from the CCU (p = 0.006), repeat operation (p = 0.03), coronary artery disease (p = 0.02), and longer ischemic (p = 0.02) and bypass times (p = 0.0003). On multivariate stepwise logistic regression analysis, use of inotropes was related to preoperative lower LVEF (p = 0.02) and urgency of operation (p = 0.0002), Perioperative complications included ventricular arrhythmia in six, heart block in one, renal dysfunction in nine, and stroke in two patients; no patient had myocardial infarction, Conclusion: Good clinical results can be obtained by using retrograde cardioplegia alone without prior doses of antegrade cardioplegia in all valve operations.