Antegrade versus simultaneous ante/retrograde cardioplegia in the presence of three vessels disease

Abstract

This study was performed to compare myocardial cell injury and the rate of reduced cardiac ejection between antegrade vs antegrade/retrograde approach to myocardial preservation. All 208 3VD patients were categorized randomly in 2 groups containing 104 cases which underwent urgent or elective Coronary Artery Bypass Grafting (CABG) with Cardio Pulmonary Bypass (CPB). The cardioplegia method in group 1 was antegrade and in group 2 was ante+retrograde. The preparation of cardioplegin solution was the same in both groups. The levels of creatine kinase MB in 3, 12 and 36 h after operation was not significantly different between two groups but were higher than normal. Also, the levels of Cardiac Troponin I in 3 and 12 h after operation was not significantly different between two groups but were higher than normal. The higher MI rate in group 1 (8 cases) than group 2 (3 cases) can be considered significant clinically but this difference was not statistically significant. There was not significant difference between the mortality between group 2 (0 case) and group 1 (1 case). The number of Intra-aortic balloon pump insertion in both groups was the same. The time of aortic clamping and pump time was not different significantly between two groups. Although postoperative EF was decreased in both groups, this decrease was much higher in group 1 especially in those with severe (90% or complete cut) LAD and RCA lesions. We concluded that there is no significant preference among antegrade and antegrade/ retrograde approach to myocardial preservation.