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Antegrade/retrograde cardioplegia in arterial bypass grafting: metabolic randomized clinical trial
O Jegaden1, A Eker, P Montagna
1Department of Cardiovascular Surgery, Hôpital Cardiologique, Lyon, France.
Insights
Combined antegrade/retrograde cardioplegia offers superior myocardial protection during revascularization by reducing oxidative stress. This method, compared to antegrade cardioplegia alone, shows improved metabolic effects and lower malondialdehyde levels post-reperfusion.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biochemistry
Background:
- Myocardial protection is crucial during revascularization surgery.
- Optimizing cardioplegia delivery strategies is essential for reducing myocardial damage.
- Arterial grafts are increasingly used in coronary artery bypass grafting.
Purpose of the Study:
- To compare the metabolic effects of combined antegrade/retrograde versus antegrade cardioplegia.
- To evaluate myocardial protection strategies in patients undergoing revascularization with arterial grafts.
- To assess markers of oxidative stress and cellular energy post-reperfusion.
Main Methods:
- 30 patients with three-vessel coronary artery disease received arterial grafts.
- Patients were randomized to antegrade (Group A) or combined antegrade/retrograde (Group A/R) cardioplegia.
- Metabolic markers (lactates, oxidative stress enzymes, malondialdehyde) and myocardial energy metabolites (ATP, CP) were analyzed.
Main Results:
- Group A/R showed significantly lower right ventricular temperature post-cardioplegia.
- Malondialdehyde levels increased significantly in Group A but not in Group A/R post-reperfusion.
- No significant differences were observed in left ventricular temperature, lactate, antioxidant enzymes, ATP, or creatine phosphate levels between groups.
Conclusions:
- Combined antegrade/retrograde cardioplegia provides enhanced myocardial protection by mitigating oxidative stress.
- This strategy may be beneficial in reducing reperfusion injury during coronary artery bypass grafting.
- Further research is warranted to explore the long-term clinical implications.
Abstract:
The metabolic effects of combined antegrade/retrograde and antegrade cardioplegia on myocardial protection were evaluated and compared in 30 patients who underwent myocardial revascularization. All patients had three-vessel coronary artery disease, and the revascularization was done with exclusive use of arterial grafts (internal mammary artery, gastroepiploic artery). Myocardial protection consisted of oxygenated crystalloid cardioplegia, topical slushed ice, and moderate systemic hypothermia (34 degrees C). The patients were randomly separated into two groups: group A (n = 15), who received antegrade cardioplegia, and group A/R (n = 15), who received combined antegrade/retrograde cardioplegia. There was no significant difference between the two groups concerning preoperative and intraoperative data. After the first dose of cardioplegia, right ventricular temperature was significantly lower in group A/R (15 +/- 2 degrees versus 19 +/- 5 degrees C; p < 0.05), and there was no significant difference between the two groups in left ventricular temperature. Coronary sinus blood samples were obtained before bypass and 5, 10, and 15 minutes after reperfusion; there was no difference between the two groups concerning lactates, superoxide dismutase, and glutathione peroxidase. After reperfusion, malondialdehyde levels increased significantly in group A and there was no change in group A/R, with a significant difference between the two groups (at 10 minutes after reperfusion, 0.80 +/- 0.20 versus 0.53 +/- 0.16 mumol/L; p < 0.05). Right and left ventricular myocardial biopsies were performed before bypass and 15 minutes after reperfusion; there was no significant difference between the two groups concerning adenosine triphosphate and creatine phosphate myocardial concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)