Ammar Hameed Khan, Sharjeel Abbas, Attaullah Khan Naizi, Madiha Iqbal.
Effect of route of cardioplegia delivery on myocardial protection.
J Cardiovascular Dis Jan ;13(1):10-4.

OBJECTIVE: To evaluate myocardial protection using cardioplegia solution infused only antegradely or through a combined antegrade and retrograde route in patients undergoing surgery for ischemic or valvular heart disease. MATERIALS & METHODS: This Prospective comparative study included 108 consecutive patients who underwent cardiac surgery from March 2013 to October 2014 at Punjab Institute of Cardiology, Lahore Pakistan. Patients requiring coronary artery surgery, aortic valve replacement or combined aortic and mitral valve surgery were included. Patients requiring emergency surgery, undergoing CPR pre-operatively, requiring early re-exploration or patients with LV EF ≤30% were excluded. Data was analyzed using SPSS 20. P-value ≤ 0.05 was taken as significant. RESULTS: Out of 108 patients 70(64.81%) were male. The mean age of the patients was 39.62±16.15 year. Patients included 36 in CABG group, 36 in AVR and 36 in DVR group. Half of the patients in each group were delivered cardioplegia through antegrade route only and the other half were infused cardioplegia through combined antegrade and retrograde route. Significantly lower aortic cross clamp and cardio pulmonary bypass times were observed for both AVR and DVR. (p-value< 0.05). There was a significant difference between immediate, early (after 24 hours) and post-operative (after 48 hours)mean CKMB in AVR, DVR and CABG with respect to the cardioplegia delivery groups (p-value <0.05). In all 3 surgical procedures the difference between echocardiographic characteristics of both groups was insignificant (P-value >0.05). The time of ventilation, ICU stay and total hospital stay were also found to be lower for the retrograde group. CONCLUSION: Myocardial protection using a combined antegrade and retrograde cardioplegia delivery is superior to antegrade cardioplegia used alone for Coronary artery bypass surgery and aortic valve surgery with or without mitral valve replacement. It is associated with shorter cross clamp time, shorter ventilation time, ICU and hospital stay and lower CKMB levels. KEY WORDS: CKMB, AVR: aortic valve replacement, DVR: double valve replacement, CABG: coronary artery bypass grafting, Antegrade cardioplegia, retrograde cardioplegia, left ventricular ejection fraction.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com