Right atrial electrical activity and myocardial temperatures of all four chambers were monitored during a 1 hour period of cardioplegic arrest in 20 pigs subjected to different methods of venous cannulation and cardiac cooling. Myocardial protection was provided by systemic hypothermia (28° C) and intermittent intra-aortic administration of cold (4° C) hyperkalemic (20 mEq/L) crystalloid cardioplegia. The use of a single right atrial cannula for venous drainage was associated with sustained atrial activity (50 ± 5.5 minutes) during cardioplegic arrest and the warmest right atrial (27° ± 0.2° C) and right ventricular (20.5caval cannulation with snaring and right atrial venting decreased right atrial and ventricular temperatures marginally (25.3° ± 0.5° C and 19.1 ± 0.4° C, respectively, p < 0.05) but did not significantly alter the duration of atrial electrical activity (42.2 ± 2.5 minutes, p > 0.05). Addition of an extracavitary right atrial drip of cold (4° C) saline, 750 ml for the 1 hour aortic clamping period, reduced right atrial temperature (22.8° ± 0.4° C) and activity (24.8 ± 6.3 minutes) to a significant extent. Intracavitary irrigation of the right atrium with cold saline, in the presence of snared double caval cannulas, decreased right atrial and ventricular temperatures most dramatically (17.0° ± 0.5° C and 17.5° ± 0.3° C, respectively, p < 0.05), reduced the duration of atrial electrical activity by 84% (to 8 ± 3.9 minutes, p < 0.01), and diminished the total number of atrial contractions per hour of aortic clamping by 88%. It is concluded that intracavitary right atrial cooling with separate snared caval cannulation is the most effective method of ensuring atrial inactivity and prolonged right heart hypothermia during cardioplegic arrest.
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine