Myocardial Protection with Simultaneous Antegrade/Vein Graft Cardioplegia Compared to Antegrade Cardioplegia Alone in Elective Coronary Artery Bypass Grafting Patients

Abstract

Objective: Cardioplegia distribution beyond a stenotic coronary artery may not be adequate. This problem can be overcome by direct delivery of cardioplegia via the vein grafts anastomosed during the operation. The aim of this study is to investigate the results of simultaneous antegrade/vein graft cardioplegia versus antegrade cardioplegia alone in elective CABG patients. Material and Methods: Forty consecutive patients were randomized into the study group to whom antegrade/vein cardioplegia and to the control group to whom only antegrade cardioplegia was given. Both groups were similar with respect to demographic characteristics, postoperative ECG changes and arrhythmia in the ICU, as well as in terms of operative and postoperative variables (p>0.05). Results: All patients had excellent operative and postoperative periods without any complications or death. Release of total CK, CKMB, cTnI and lactate did not differ in the preoperative and the first 12th hour (p>0.05) between the groups, whereas in the study group a peak for total CK, CKMB, cTnI and lactate, consistent with myocardial injury (p<0.05), was found in the first 24th hour, which returned in the 48th hour (p>0.05). Conclusion: The primary finding of this study is the inferiority of myocardial protection with simultaneous antegrade/vein graft cardioplegia compared with antegrade cardioplegia alone.

Keywords

• Coronary artery bypass surgery, myocardial protection, cardioplegia, vein graft, reperfusion injury

Myocardial Protection with Simultaneous Antegrade/Vein Graft Cardioplegia Compared to Antegrade Cardioplegia Alone in Elective Coronary Artery Bypass Grafting Patients

Öz

Kaynakça

1. Buckberg GD. Antegrade/retrograde blood cardioplegia to en- sure cardioplegic distribution: operative techniques and objec- tives. J Card Surg 1989; 4: 216-38.
2. Menasché P, Subayi J-B, Veyssié L, Le Dref O, Chevret S, Piwnica A. Efficacy of coronary sinus cardioplegia in patients with complete coronary artery occlusions. Ann Thorac Surg 1991;51:418-23.
3. Salerno TA, Houck JP, Barrozo CA, Panos A, Christakis GT, Abel JG et al. Retrograde continuous warm blood cardioplegia: a new concept in myocardial protection. Ann Thorac Surg 1991; 51: 245-7.
4. Aldea GS, Hou D, Fonger JD, Shemin RJ. Inhomogenous and complementary antegrade and retrograde delivery of cardiople- gic solution in the absence of coronary artery obstruction. J Tho- rac Cardiovasc Surg 1994;107:499-504.
5. Onem G, Sacar M, Baltalarli A, Ozcan AV, Gurses E, Sungurtekin H. Comparison of simultaneous antegrade/vein graft cardiople- gia for myocardial protection. Adv in Therapy 2006; 23: 869-77.
6. Menasche P, Subayi JB, Veyssie L, le Dref O, Chevret S, Piwnika A. Efficacy of coronary sinus cardioplegia in patients with complete coronary artery occlusion. Ann Thorac Surg 1991;51:418-23.
7. Fabiani JN, Deloche A, Swanson J, Carpentier A. Retrograde car- dioplegia through the right atrium. Ann Thorac Surg 1986;41:101-2.
8. Carrier M, Gregorie J, Khalil A, Thai P, Latour JG, Pelletier LC. Myocardial distribution of retrograde cardioplegic solution as- sessed by myocardial thallium 201 uptake. J Thorac Cardiovasc Surg 1994;108:1115-8.

9. Hirata N, Sakai K, Ohtani M, Sakaki S, Ohnishi K. Assessment of myocardial distribution of retrograde and antegrade car- dioplegic solution in the same patients. Eur j Cardiothorac Surg 1997;12:242-7.
10. Vähäsilta T, Saraste A, Kytö V, Malmberg M, Kiss J, Kentala E et al. Cardiomyocyte apoptosis after antegrade and retrograde cardioplegia. Ann Thorac Surg 2005; 80: 2229-34.