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Delivers potassium-enriched solution during cardiopulmonary bypass Functions: Creates motionless surgical field; Reduces myocardial metabolic demand Mechanism: Increased extracellular potassium → cardiac arrest in diastole Cooling the solution reduces metabolic activity by up to 97% → Allows up to 40 minutes of protected perfusion-free time Anterograde Cardioplegia Traditional delivery method Administered via small-bore catheter/needle into: Aortic root Direct coronary artery injection Limitations: Less effective with distorted aortic/coronary anatomy Problematic with severe aortic insuff (AI): Backflow into left ventricle can cause myocardial distention and increased metabolic demand Reduced efficacy with CAD Retrograde Cardioplegia Delivered through coronary sinus using balloon-tipped catheter Primary indications: severe AI, significant CAD, complex procedures involving proximal coronary arteries/aortic root Limitations: Poor distribution to right coronary artery territory (especially anterior free wall); Relative capillary hypoperfusion Modern approach is combination of anterograde and retrograde → may provide superior myocardial protection versus either method alone Patient selection remains important for optimal outcomes