Key result
Antegrade plus retrograde continuous cardioplegia linked to ~41% fewer postoperative conduction disorders vs intermittent antegrade alone.
Why the study?
Conduction disorders after coronary artery bypass surgery have multiple causes, and the impact of different cardioplegia delivery methods on these disorders was evaluated.
Does antegrade plus retrograde continuous cardioplegia reduce postoperative conduction disorders in patients undergoing CABG compared to intermittent antegrade cardioplegia alone?
Cohort (n=1,824)
Does antegrade plus retrograde continuous cardioplegia reduce postoperative conduction disorders in patients undergoing CABG compared to intermittent antegrade cardioplegia alone?
Absolute Event Rate: 4.6% vs 7.8%
p-value: p=0.006
The use of antegrade plus retrograde continuous cardioplegia during CABG significantly reduces the incidence of postoperative conduction disorders compared to intermittent antegrade cardioplegia alone.
May reduce post-CABG conduction disorders with combined cardioplegia; leaves open need for randomized trials before practice change.
BACKGROUND: Conduction disorders appearing after coronary artery bypass surgery (CABG) may have many different causes. In this study, we evaluated the postoperative conduction disorders after CABG with respect to the ante-grade blood cardioplegia and ante-grade plus continuous retrograde cardioplegia delivery methods. MATERIALS AND METHODS: This retrospective study included 1824 patients undergoing CABG between January 2001 and December 2005. There were 694 female patients (38%) and 1130 male patients (62%). Myocardial protection was done by isothermic hyperkalemic blood cardioplegia. Patents in Group 1 (n = 704) were operated on using only intermittent antegrade cardioplegia and those in group 2 (n = 1120) were operated on using the antegrade plus retrograde continuous cardioplegia. The postoperative occurrences of a new right bundle branch block, left anterior hemiblock, left posterior hemiblock, left bundle branch block, or third-degree atrioventricular block were evaluated and compared. RESULTS: Total mortality rate was 1.6% (29 patients) without significant difference between the groups. The preoperative and perioperative characteristics were statistically similar in the groups. The occurrence of conduction disorders was significantly higher in group 1 (P = .006, 55 versus 52 patients). The analysis of the patients with conduction disorders showed a significantly increased mortality rate (P < .001) in addition to a significantly increased period of intensive care unit follow-up and duration of postoperative hospitalization (P <.001). CONCLUSION: The present study demonstrated that the perioperative occurrence of conduction disorders after CABG was decreased by antegrade controlled and retrograde continuous combination cardioplegia.
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Bolcal et al. (2006) conducted a cohort in coronary artery bypass surgery (CABG) (n=1,824). antegrade plus retrograde continuous cardioplegia vs. intermittent antegrade cardioplegia was evaluated on postoperative occurrences of a new right bundle branch block, left anterior hemiblock, left posterior hemiblock, left bundle branch block, or third-degree atrioventricular block (p=0.006). Antegrade plus retrograde continuous cardioplegia was associated with a lower rate of postoperative conduction disorders compared to intermittent antegrade cardioplegia alone (4.6% vs 7.8%, P=0.006).
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