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J Thorac Cardiovasc Surg 2003;126:1345-1351
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Does antegrade blood cardioplegia alone provide adequate myocardial protection in patients with left main stem disease?

^a Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy

Received for publication December 29, 2002; revisions received February 5, 2003; accepted for publication April 8, 2003.

^* Address for reprints: Attilio Renzulli, MD, FECTS, Via Aquila 144, 80143 Napoli, USA
arenzul{at}tin.it

BACKGROUND:: The optimum route for cardioplegia administration in patients with severe coronary disease is still under debate. This study compared clinical, echocardiographic, and biochemical results in patients with left main stem disease treated with 2 different strategies of myocardial protection.

METHODS: Between March 2000 and November 2002, 148 consecutive patients with left main stem disease undergoing coronary artery bypass grafting were divided into 2 groups according to the route of cardioplegia delivery: antegrade in 87 patients (group A) or antegrade followed by retrograde in 61 patients (group B). Electrocardiography, troponin I, MB-creatine kinase, and MB-creatine kinase mass were performed at 12, 24, 48, and 72 hours postoperatively. Echocardiography was performed preoperatively and before hospital discharge. Data were stratified in subgroups of patients with the following associated risk factors: left ventricular hypertrophy, diabetes, and right coronary stenosis.

RESULTS: Groups were homogeneous in preoperative and intraoperative variables, apart from the higher incidence of unstable angina and severity of left main stem disease in group B. Hospital deaths, intensive therapy unit and hospital stay, perioperative acute myocardial infarction, and intraaortic balloon pump support were similar in both groups. Postoperative recovery of left ventricle ejection fraction and wall motion score index did not differ between the 2 groups. However, postoperative atrial fibrillation was higher in group A (P = .015), especially in patients with diabetes (P < .0001). Troponin I was significantly higher in group A from postoperative hours 12 to 72 (P < .01), and the same pattern was observed in patients with diabetes (P < .001), critical right coronary stenosis (P < .001), and left ventricle hypertrophy (P < .001).

CONCLUSION: The combined route of intermittent blood cardioplegia allows better results in left main stem disease. Such data are confirmed even in risk subgroups.

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