COMPARISON OF ANTEGRADE WITH ANTEGRADE RETROGRADE COLD BLOOD CARDIOPLEGIA FOR MYOCARDIAL REVASCULARIZATION/

There has been increasing interest in the use of retrograde coronary s inus perfusion for delivery of cardioplegic solution during myocardial revascularization. Despite evidence of improved cardiac protection, i t is unclear if a combined antegrade/retrograde approach to myocardial preservation offers significant clinical benefits. One hundred twenty patients undergoing elective Ist-lime coronary bypass surgery for 3-o r-more-vessel disease received aortic root, antegrade cold blood cardi oplegia (Group I, n = 52) or combined antegrade/retrograde cardioplegi a via coronary sinus cannulation (Group II, n = 68). All preoperative variables were similar, including age, seventy of coronary artery dise ase, functional status, and ejection fraction. intraoperative and post operative variables, including the degree of hypothermia, temperature of infusion solution, number of bypass grafts, defibrillation attempts and spontaneous return to sinus rhythm, the use of intraaortic balloo n pump counterpulsation, and inotropic support during weaning from car diopulmonary bypass, were not statistically different. Cardioplegia in fusion time was longer in Group ii than in Group I (2.5 +/- 0.8 vs 1.7 +/- 0.7 min, p < 0.05). The postoperative cardiac output, electrocard iographic and cardiac enzyme evidence of ischemia, the need for tempor ary pacing, and 30-day morbidity and mortality were similar for both g roups. The data indicate that in this non-risk-stratified group of pat ients, the route of cardioplegia administration is not a determinant o f clinical outcome.