Randomized Prospective Study:Comparison Between Continuous Antegrade And Continuous Retrograde Cardioplegia During Heart Valve Replacement Procedure

The study recruited the patients who underwent complex rheumatic heart valvereplacement procedures （at least mitral and aortic valve need replacemnt）at changhaihospital, and were randomly assigned according to the route of cardioplegic solution infusions.One group is continuous retrograde and the other one is continuous antegrade perfusion, andthe purpose of our study included hemodynamics, measurement of Biochemical Markers,cardiac apoptosis and postoperative follow-up, from different aspectat different time point(at3h,6h,12h,24h,48h after the operation) to compare each method and evaluate myocardialapoptosis,recovery of cardiac function and the injury of myocardium.Materials40patient who suffered from Complex Rheumatic heart valve and needed heart valvereplacement procedures were randomized into two groups:group one which cardiaplegia wasdelivery antegradely with a large-bore double-lumen needle contained20patient; the othergroup was administered by an antegrade induction followed by continuous retrogradeperfusion through a fexible catheter with a antoually infated distal balloon, there is nosignificant demographic characteristics differences between two group and all patient wasfollowed by similar protocolMethod:The assessment of Hemodynamics were made by the thermodilution technique beforethe surgery,3hours,6hours,12hours,24hours after surgery. And the determination of serumlevels of CK-MB, troponin T were obtained before the surgery3h,6h,12h,24h, and48hoursafter coming off a bypass, The biopsy specimens were taken from the right atrial myocardiumafter cardiac arrest and after aortic declamping for the measurement of TUNEL. Postoperativearrhythmias and the clinic data about Preoperative course, Perioperative Course andPostoperative Course was recorded.All analyses were performed using the SPSSs of the wareversion18.0.Results were considered signifcant if p <0.05. Result:there is no severely perioperative mortality or morbidity in the both administration. Theaortic cross-clamp time was signifcantly decreased in the antegrade group(72.95±13.08min)compared to retrograde group(79.25±20.71)(p=0.051). and there was a relatively largevariation between the two groups in CPB time the antegroup were111.25±15.91minutesand125.00±24.6minutes in retrograde group(P=0.043), There is a downfall in CI, LVSWI,and SWI within12h after surgery in both group.Compared with retrograde group,there areno signifcant difference in CI,LVSWI, RVSWI, and SVRI, Accordingly,The release ofCTnT and CK-MB were show significant different between both groups(P<0.05), both groupssuffer an upboost and gradually fall down with48h, the percentages of apoptosis werecomparable in both the antegrade group and the retrograde group.Conclusion:Compared continuous retrograde cardioplegia,the continuous antegrade approachdelivery show no signifcant difference in Hemodynamic change and recovery after the earlysurgery,but continuous antegrade approach can reduce cardiac damage of the patient whosuffered from complex rheumatic heart valve replacement procedures...