Delivering Cardioplegia Beyond Totally Occluded Native Coronary Arteries Through the Saphenous Bypass Vein Graft: Is It Really a Protective Technique?

Abstract

Introduction: Antegrade route may fail to provide homogenous cardioplegia distribution in patients with totally occluded coronary arteries. Cardioplegia via vein graft beyond occlusion is considered as an alternative approach to achieve better myocardial protection. In this study, we aimed to compare myocardial protection achieved with antegrade cardioplegia and antegrade plus vein graft cardioplegia in patients with totally occluded coronaries. Patients and Methods: Consecutive 14 patients with at least one totally occluded coronary artery were randomly divided into two groups. Antegrade cardioplegia was used in group 1, antegrade plus vein graft cardiplegia was used in group 2. Creatine kinase, creatine kinase MB, lactate and troponine I levels were measured for myocardial damage monitorization. Samples were collected from the arterial line and coronary sinus simultaneously; at the beginning of the operation before extracorporal circulation institution (1), after completion of the distal anastomosis, immediately after "hot shot" cardioplegia infusion and aortic unclamping (2) and after removal of the side clamp (3). Measurements were repeated at the 6th (4), 12th (5), 24th (6) and 48th (7) postoperative hours from the peripheral arterial line. Groups were compared statistically. Results: In this study, cardiac enzymes and transcoronary lactate gradient were found similar in each measurement. Conclusion: Antegrade cardioplegia may achieve adequate myocardial protection in patients with totally occluded coronary arteries. Antegrade plus vein graft cardioplegia does not seem to provide any advantage in this spesific patient group.