Does Combined Antegrade-Retrograde Cardioplegia Have Any Superiority Over Antegrade Cardioplegia?

Background: In a prospective randomised clinical study we assessed and compared antegrade vs. combined antegrade-retrograde cardioplegia in patients who underwent elective coronary artery by pass grafting.

Methods: Between March 2006 and January 2007, 87 consecutive patients were randomly divided into two groups. Group A (n=45) received antegrade cold (4 degrees C) blood cardioplegia. Besides antegrade cardioplegia, Group B (n=42) received continuous retrograde cardioplegia passively by gravitational force. The need for cardiac support during and after cardiopulmonary bypass, post-operative morbidity, ICU stay, hospital stay and mortality were compared in two groups.

Results: There was no significant difference between the two groups in gender, age and pre-operative ejection fraction. Sixteen patients in Group A (35.5%) and eight patients in Group B (19%) needed inotropic support while weaning off cardiopulmonary bypass (p=0.04). Four patients in Group A (8.9%) and two patients in Group B (4.8%) needed intra-aortic balloon pump (p=0.44) in the ICU. We found no statistically important difference between the two groups in post-operative morbidity and mortality.

Conclusions: Retrograde continuous infusion of cardioplegia by gravitational force combined with antegrade cardioplegia, provides satisfactory myocardial protection and eliminates the need for inotropic support compared with antegrade technique alone.