Does antegrade blood cardioplegia alone provide adequate myocardial protection in patients with left main stem disease?
BACKGROUND
The optimum route for cardioplegia administration in patients with severe coronary disease is still under debate. This study compared clinical, echocardiographic, and biochemical results in patients with left main stem disease treated with 2 different strategies of myocardial protection.


METHODS
Between March 2000 and November 2002, 148 consecutive patients with left main stem disease undergoing coronary artery bypass grafting were divided into 2 groups according to the route of cardioplegia delivery: antegrade in 87 patients (group A) or antegrade followed by retrograde in 61 patients (group B). Electrocardiography, troponin I, MB-creatine kinase, and MB-creatine kinase mass were performed at 12, 24, 48, and 72 hours postoperatively. Echocardiography was performed preoperatively and before hospital discharge. Data were stratified in subgroups of patients with the following associated risk factors: left ventricular hypertrophy, diabetes, and right coronary stenosis.


RESULTS
Groups were homogeneous in preoperative and intraoperative variables, apart from the higher incidence of unstable angina and severity of left main stem disease in group B. Hospital deaths, intensive therapy unit and hospital stay, perioperative acute myocardial infarction, and intraaortic balloon pump support were similar in both groups. Postoperative recovery of left ventricle ejection fraction and wall motion score index did not differ between the 2 groups. However, postoperative atrial fibrillation was higher in group A (P =.015), especially in patients with diabetes (P <.0001). Troponin I was significantly higher in group A from postoperative hours 12 to 72 (P <.01), and the same pattern was observed in patients with diabetes (P <.001), critical right coronary stenosis (P <.001), and left ventricle hypertrophy (P <.001).


CONCLUSIONS
The combined route of intermittent blood cardioplegia allows better results in left main stem disease. Such data are confirmed even in risk subgroups.
Onorati
Francesco
F
Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Italy.
Renzulli
Attilio
A
De Feo
Marisa
M
Santarpino
Giuseppe
G
Gregorio
Rosario
R
Biondi
Andrea
A
Cerasuolo
Flavio
F
Cotrufo
Maurizio
M
D000328:Adult; D000368:Aged; D002314:Cardioplegic Solutions / Q000627:therapeutic use; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
D002314:Cardioplegic Solutions