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Continuous or intermittant retrograde cardioplegia during coronary bypass: A propensity score adjusted comparison
Kemal Uzun1, Muhammet Onur Hanedan1, Hakan Kara2
1Department of Cardiovascular Surgery, Trabzon University Faculty of Medicine, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Türkiye.
Insights
Intermittent retrograde cardioplegia improves surgical vision during coronary artery bypass grafting by providing a bloodless field. This method offers equivalent myocardial protection compared to continuous delivery, enhancing procedural comfort.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
Background:
- Continuous retrograde cardioplegia can impair surgeon's view during distal anastomosis in coronary artery bypass grafting (CABG).
- Optimizing myocardial protection while improving surgical conditions is crucial for CABG outcomes.
Purpose of the Study:
- To compare the efficacy of intermittent versus continuous retrograde cardioplegia in CABG.
- To assess the impact of intermittent retrograde cardioplegia on myocardial protection and surgical field visualization.
Main Methods:
- Retrospective analysis of 234 patients undergoing CABG with ≥2 target vessel revascularization.
- Comparison of continuous (gravity-fed) and intermittent (pressure-controlled) retrograde cardioplegia administration.
- Standardized use of isothermic, potassium-enriched blood cardioplegia with antegrade induction.
Main Results:
- The intermittent group received a significantly higher volume of cardioplegia solution (4070 ± 760 mL vs. 3190 ± 575 mL; p = 0.001).
- No significant differences were found in postoperative clinical outcomes or early mortality rates between the groups.
- Intermittent retrograde cardioplegia provided a bloodless surgical field and improved procedural comfort.
Conclusions:
- Intermittent retrograde cardioplegia enhances operative conditions during CABG by ensuring a clear surgical field.
- This technique maintains myocardial protection comparable to the continuous method.
- Intermittent retrograde cardioplegia is a viable alternative for improving surgical efficiency in CABG.
Abstract:
IntroductionContinuous retrograde cardioplegia worsens surgeon's vision while performing distal anastomosis in coronary artery bypass grafting operations. We investigated whether intermittent retrograde cardioplegia, which provides a bloodless surgical field by interrupting cardioplegia flow during distal anastomosis, poses a disadvantage in terms of myocardial protection.MethodsThis retrospective study was conducted in two different heart centres between January 2013 and July 2023. A total of 234 patients who underwent ≥2 target vessel revascularization under cardiopulmonary bypass were examined. Isothermic, potassium-enriched blood cardioplegia was used and induction was performed antegrade in all patients. In addition to antegrade, we routinely gave retrograde cardioplegia. Retrograde cardioplegia was applied continuously with the force of gravity in the continuous group (n = 167), and intermittently with pressure in the intermittent group (n = 167).ResultsThe volume of cardioplegia solution administered was significantly higher in the intermittent group compared to the continuous group (4070 ± 760 mL vs 3190 ± 575 mL; p = 0.001). However, no significant differences were observed between the groups regarding postoperative clinical outcomes or early mortality rates.ConclusionsIntermittent retrograde cardioplegia offers superior operative conditions by ensuring a bloodless surgical field and improved procedural comfort, while maintaining equivalent efficacy in myocardial protection compared with the continuous method.
