Results of Combined Antegrade and Retrograde Versus Antegrade Cardioplegia in Complex Coronary Artery Bypass Surgeries

Abstract

Background: Myocardial protection during complex coronary artery bypass surgery, especially for the right ventricle, faces challenges due to severe coronary lesions that hinder antegrade cold cardioplegia delivery, potentially causing asymmetric myocardial cooling, postoperative left and right ventricular dysfunction. The ongoing debate over optimal cardioplegia routes and compositions continues to influence myocardial protection outcomes in ischemic heart disease. We aimed to compare simultaneous antegrade-retrograde cardioplegia with antegrade cardioplegia in complex coronary artery bypass surgeries.

Results: One hundred twenty-eight patients were randomized into two groups: Group A (n=64) received antegrade cardioplegia only, and Group B (n=64) received ante-retrograde cardioplegia. Both groups were compared for demographic characteristics, pre- and postoperative echocardiographic data, bypass and ischemic times, number of grafts, serum lactate levels at 1 and 24 hours, and inotropic support. No substantial differences were found between the two groups in terms of demographic characteristics, with the exception of weight (P=0.0058) and BMI (P=0.0375). Significant differences were observed in the duration of inotropic support (P<0.001), while pre- and postoperative echocardiographic data, bypass time (P=0.9321), ischemic time (P=0.8296), and number of grafts (P=0.236) remained comparable. However, serum lactate levels at 1 hour (P<0.001) and 24 hours (P=0.0142) differed significantly which is lower in Ante-retrograde group than Antegrade group. Notably, both the Antegrade and Ante-Retrograde groups exhibited significantly lower serum lactate levels at 1 and 24 hours (P < 0.001 for both).

Conclusions: The ante-retrograde group had shorter inotropic support duration and significantly lower serum lactate levels at 1 hour and 24 hours, suggesting better myocardial perfusion and metabolism recovery, indicating improved cardiac function with ante-retrograde cardioplegia.