Surgery for Left Ventricular Outflow Obstruction: Aortic Valve Replacement and Myomectomy

Abstract

1. After cardiopulmonary bypass has been established, the patient’s systemic temperature is lowered to 28°C, the aorta is cross-clamped, and cardioplegia is administered. If there is no aortic insufficiency, most surgeons administer the initial dose antegrade via a catheter placed in the aortic root. Subsequent dosing can be given generally by one of two routes: directly into the individual coronary ostia or by way of retrograde coronary sinus cardioplegia. The authors’ preference is retrograde coronary sinus cardioplegia, because surgery can progress uninterrupted while cardioplegia is administered; with ostial cannulation the surgeon needs to stop the operation to hold the cardioplegia cannulae. In addition, there is a small but distinct chance of injury secondary to placement of the ostial cannulae. If there is aortic insufficiency, then the cardioplegia must be administered directly or via retrograde coronary sinus cardioplegia throughout the operation.