Comparison of effect of antegrade with combined antegrade/retrograde cardioplegia on inflammatory response and left ventricular systolic function in coronary bypass surgery: a prospective randomized study

Aim: Nonhomogeneous distribution of antegrade cardioplegia especially in cases with severe myocardial hypertrophy or proximal stenosis of coronary arteries may be a serious problem. This prospective randomized study was designed to determine whether combined antegrade–retrograde cardioplegia provides improved myocardial protection in the early period and is associated with better laboratory results compared with antegrade technique alone.Material and Methods: A total of 60 patients who underwent coronary artery bypass grafting surgery, 45 (75%) males and 15 (25%) females, were included in the study as 2 groups: In Group 1, 30 patients were given the combined cardioplegia solution antegrade via the aortic root and retrograde via the coronary sinus, in Group 2, 30 patients were given only antegrade cardioplegia solution via the aortic root. The CK-MB, TpI, TNF- α, IL-1, IMA, ICAM-1, and BNP parameters were studied in the blood samples which were taken preoperatively, intraoperatively and postoperative sixth day. The patients were evaluated preoperatively and on the sixth postoperative day using transthoracic echocardiography.Results: The postoperative mean EF decrease was significantly lower in Group 1 compared to Group 2 (4.13 ± 9.09 vs 8.90 ± 10.76 in Group 1 vs. Group 2, respectively, p=0.046). When the change in TNF-α levels were compared between groups 1 and 2, the magnitude of increase in TNF-α was significantly higher in Group 2 (p=0.047). Conclusion: We concluded that co-administration of antegrade and retrograde cardioplegia may provide improved myocardial protection compared to antegrade cardioplegia method alone in the early postoperative period.