title: A retrospective analysis of myocardial preservation techniques during coronary artery bypass graft surgery: are we protecting the heart?
abstract: BACKGROUND
  Retrograde perfusion into coronary sinus during coronary artery bypass graft (CABG) surgery reduces the need for cardioplegic interruptions and ensures the distribution of cardioplegia to stenosed vessel territories, therefore enhancing the delivery of cardioplegia to the subendocardium. Peri-operative myocardial injury (PMI), as measured by the rise of serum level of cardiac biomarkers, has been associated with short and long-term clinical outcomes. We conducted a retrospective analysis to investigate whether the combination of antegrade and retrograde techniques of cardioplegia delivery is associated with a reduced PMI than that observed with the traditional methods of myocardial preservation.
  
  
  METHODS
  Fifty-four consecutive patients underwent CABG surgery using either antegrade cold blood cardioplegia (group 1, n = 28) or cross-clamp fibrillation (group 2, n = 16) or antegrade retrograde warm blood cardioplegia (group 3, n = 10). The study primary end-point was PMI, evaluated with total area under the curve (AUC) of high-sensitivity Troponin-T (hsTnT), measured pre-operatively and at 6, 12, 24, 48 and 72 hours post-surgery. Secondary endpoints were acute kidney injury (AKI) and inotrope scores, length of intensive care unit (ICU) and hospital stay, new onset atrial fibrillation (AF) and clinical outcomes at 6 weeks (death, non-fatal myocardial infarction, coronary artery revascularization, stroke).
  
  
  RESULTS
  There was evidence that mean total AUC of hsTnT was different among the three groups (P = 0.050). In particular mean total AUC of hsTnT was significantly lower in group 3 compared to both group 1 (-16.55; 95% CI: -30.08, -3.01; P = 0.018) with slightly weaker evidence of a lower mean hsTnT in group 3 when compared to group 2 (-15.13; 95% CI -29.87, -0.39; P = 0.044). There was no evidence of a difference when comparing group 2 to group 1 (-1.42,; 95% CI: -12.95, 10.12, P = 0.806).
  
  
  CONCLUSIONS
  Our retrospective analysis suggests that, compared to traditional methods of myocardial preservation, antegrade retrograde cardioplegia may reduce PMI in patients undergoing first time CABG surgery.
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, UK. luciano2108@hotmail.com.
authors.forename: Luciano
authors.initials: L
authors.lastname: Candilio
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, UK. a.m.malik@ucl.ac.uk.
authors.forename: Abdul
authors.initials: A
authors.lastname: Malik
authors.affiliation: The Nuffield Trust, London, UK. cono.ariti@nuffieldtrust.org.uk.
authors.forename: Con
authors.initials: C
authors.lastname: Ariti
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK. drsherbano@gmail.com.
authors.forename: Sherbano A
authors.initials: SA
authors.lastname: Khan
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK. matthew.barnard@uclh.nhs.uk.
authors.forename: Matthew
authors.initials: M
authors.lastname: Barnard
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK. carmelo.disalvo@uclh.nhs.uk.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Di Salvo
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK. david.lawrence@uclh.nhs.uk.
authors.forename: David R
authors.initials: DR
authors.lastname: Lawrence
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK. martin.hayward@uclh.nhs.uk.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Hayward
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK. john.yap@uclh.nhs.uk.
authors.forename: John A
authors.initials: JA
authors.lastname: Yap
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK. amir.sheikh@uclh.org.
authors.forename: Amir M
authors.initials: AM
authors.lastname: Sheikh
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK. christopher.mcgregor@uclh.nhs.uk.
authors.forename: Christopher G A
authors.initials: CG
authors.lastname: McGregor
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK. shyam.kolvekar@uclh.nhs.uk.
authors.forename: Shyam K
authors.initials: SK
authors.lastname: Kolvekar
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, UK. d.hausenloy@ucl.ac.uk.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Hausenloy
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, UK. d.yellon@ucl.ac.uk.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Yellon
authors.affiliation: The Heart Hospital, University College London Hospital, London, UK. Neil.Roberts@uclh.nhs.uk.
authors.forename: Neil
authors.initials: N
authors.lastname: Roberts
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome