A retrospective analysis of myocardial preservation techniques during coronary artery bypass graft surgery: Are we protecting the heart?

Luciano Candilio, Abdul Malik, Con Ariti, Sherbano A. Khan, Matthew Barnard, Carmelo Di Salvo, David R. Lawrence, Martin P. Hayward, John A. Yap, Amir M. Sheikh, Christopher G.A. McGregor, Shyam K. Kolvekar, Derek J. Hausenloy, Derek M. Yellon, Neil Roberts

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background: Retrograde perfusion into coronary sinus during coronary artery bypass graft (CABG) surgery reduces the need for cardioplegic interruptions and ensures the distribution of cardioplegia to stenosed vessel territories, therefore enhancing the delivery of cardioplegia to the subendocardium. Peri-operative myocardial injury (PMI), as measured by the rise of serum level of cardiac biomarkers, has been associated with short and long-term clinical outcomes. We conducted a retrospective analysis to investigate whether the combination of antegrade and retrograde techniques of cardioplegia delivery is associated with a reduced PMI than that observed with the traditional methods of myocardial preservation. Methods: Fifty-four consecutive patients underwent CABG surgery using either antegrade cold blood cardioplegia (group 1, n = 28) or cross-clamp fibrillation (group 2, n = 16) or antegrade retrograde warm blood cardioplegia (group 3, n = 10). The study primary end-point was PMI, evaluated with total area under the curve (AUC) of high-sensitivity Troponin-T (hsTnT), measured pre-operatively and at 6, 12, 24, 48 and 72 hours post-surgery. Secondary endpoints were acute kidney injury (AKI) and inotrope scores, length of intensive care unit (ICU) and hospital stay, new onset atrial fibrillation (AF) and clinical outcomes at 6 weeks (death, non-fatal myocardial infarction, coronary artery revascularization, stroke). Results: There was evidence that mean total AUC of hsTnT was different among the three groups (P = 0.050). In particular mean total AUC of hsTnT was significantly lower in group 3 compared to both group 1 (-16.55; 95% CI: -30.08, -3.01; P = 0.018) with slightly weaker evidence of a lower mean hsTnT in group 3 when compared to group 2 (-15.13; 95% CI -29.87, -0.39; P = 0.044). There was no evidence of a difference when comparing group 2 to group 1 (-1.42,; 95% CI: -12.95, 10.12, P = 0.806). Conclusions: Our retrospective analysis suggests that, compared to traditional methods of myocardial preservation, antegrade retrograde cardioplegia may reduce PMI in patients undergoing first time CABG surgery.

Original languageEnglish (US)
Article number184
JournalJournal of Cardiothoracic Surgery
Volume9
Issue number1
DOIs
StatePublished - Dec 31 2014
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020 Royal Society Publishing. All rights reserved.

Keywords

  • Antegrade cardioplegia
  • Coronary artery bypass graft surgery
  • Cross-clamp fibrillation
  • Peri-operative myocardial injury
  • Retrograde cardioplegia

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