Changes of biventricular function after CABG surgery: does cardioplegia type matter?

Area of Science:

• Cardiology
• Cardiac Surgery
• Cardioplegia Research

Background:

• Coronary artery bypass grafting (CABG) is a common cardiac procedure.
• The choice of cardioplegia solution can influence myocardial protection and postoperative cardiac function.
• Biventricular function assessment is crucial for predicting outcomes after cardiac surgery.

Purpose of the Study:

• To evaluate whether the type of cardioplegia administered during CABG surgery is a significant predictor of biventricular function changes.
• To compare the effects of crystalloid cardioplegia (CC) versus Buckberg cardioplegia (BC) on cardiac geometry and function post-CABG.

Main Methods:

• A prospective study involving 81 patients undergoing CABG, excluding those with acute MI, impaired LV function, or atrial fibrillation.
• Transthoracic echocardiography (TTE) assessed biventricular parameters pre-operatively, on postoperative day 1, and at 6 months.
• Patients were randomized into two groups: CC (n=49) and BC (n=32).

Main Results:

• The BC group showed significantly better right ventricular (RV) reverse remodeling, including reduced RV and right atrial diameters, and improved longitudinal RV function (TAPSE, RV S') at 6 months.
• RV global systolic function diminished postoperatively in both groups, with a greater reduction in the CC group.
• Left ventricular (LV) systolic function and left atrial diameter changes did not differ between groups, but LV diastolic function improved significantly in the BC group at 6 months (decreased E/e', augmented septal e').

Conclusions:

• Buckberg cardioplegia (BC) is associated with favorable RV reverse remodeling and enhanced longitudinal RV function following CABG surgery.
• BC also contributes to improved left ventricular diastolic function at the late follow-up period after CABG.
• The type of cardioplegia is an important factor influencing biventricular recovery and remodeling post-CABG.