Our modified technique of combined antegrade-vein graft cardioplegia infusion versus conventional antegrade method in coronary artery bypass grafting. A randomized clinical trial

Background: To determine the efficacy of antegrade cardioplegia supplemented with venous graft perfusion in patients scheduled for coronary artery bypass grafting (CABG). Methods: 223 consecutive patients scheduled for isolated CABG were randomized to receive either continuous crystalloid cardioplegia via vein grafts on completion of each distal anastomosis plus intermittent blood cardioplegia through aortic root (group 1, n=110) or antegrade blood cardioplegia alone (group 2, n=113). Two groups were similar in terms of preoperative patients' and procedural characteristics. The primary end-points were low output syndrome (LOS) variables. Results: The inotrope and intra-aortic balloon pump demand during weaning were significantly higher in the control group (31.8% vs. 20%, p=0.043 and 7.9% vs. 1.8%, p=0.034 respectively). Postoperative level of potassium and arterial base excess (BE), stood in the normal range in both groups, despite significant inter-group differences. Peak serum level of myocardial injury biomarkers (CK, CK-MB, and cTnI) at 12 h following operation, though markedly greater in the group 2, did not reach the cut-off point of myocardial necrosis. Postoperative arrhythmia was more commonly encountered in the control group (p=0.045). The duration of ventilation and hospital stay were considerably longer in the group 2. In a subgroup with LVEF < 30%, the length of ICU stay was more prolonged in the control group, as well (p=0.0145). The significant differences among groups regarding LOS parameters were more remarkable in the two high-risk subgroups (LVEF < 30%, left main coronary stenosis). Conclusions: Given the better postoperative cardiac performance, we recommend this method to all CABG candidates, particularly in higher-risk patients.