Should We Give Combined Antegrade-Retrograde Cardioplegia Rather Than Antegrade Alone in Patients with Left Main Coronary Disease?

1 Anaesthesia Dept., Faculty of Medicine, Ain Shams Univ., Egypt. 2 Anaesthesia Dept., Faculty of Medicine, El-Fayum Univ., Egypt. 3 Cardiac surgery Dept., Faculty of Medicine, El Azhar Univ., Egypt. -----------------------------------------------------------------------------------------------------Abstract: There is still a debate about the cardioplegia administration method in patients with left main coronary disease. This prospective randomized study compared clinical, echocardiographic, markers of myocardial damage, morbidity and mortality in 103 consecutive patients with left main coronary artery disease treated with 2 different ways of giving the cardioplegic solutions. Patients were allocated into 2 groups according to the route of cardioplegia administration: combined antegrade-retrograde in 52 patients (group A) and antegrade alone in 51 patients (group B). The biochemical markers for myocardial damage showed statistically higher values in patients who underwent antegrade cardioplegia alone (group B) (P< 0.05) , however, its levels never fulfilled the criteria of perioperative myocardial infarction. Postoperative recovery of left ventricular ejection fraction and wall motion score index did not differ significantly between the 2 groups.It was concluded that The combined antegrade-retrograde route of giving cardioplegia reduces ischemic injury and permits early recovery of myocardial function more than giving antegrade alone in patients with left main coronary artery disease.