Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison of retrograde-antegrade and antegrade alone cardioplegia solution injection on inotrope requirement and mortality in patients after coronary artery bypass graft surgery

Document Type : Original Article (s)

Authors
Alireza Hosseini 1
Elahe Esmaeili Largani 2
Mehran Shahzamani 3
Asieh Maghami-Mehr 4
1 Assistant Professor of Cardiovascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
2 MSc Student, Circulation technology, School of medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Associate Professor of Cardiovascular Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Statistics, Yazd University, Yazd, Iran
10.48305/jims.v43.i847.1995
Abstract
Background: One of the major concerns during cardiac surgery is heart protection; in this regard, cardioplegia solution is used by retrograde and antegrade methods or a combination of these two methods. This study was conducted with the aim of comparing the injection of two methods of cardioplegia solution injection(retrograde-antegrade method and antegrade alone) on the need for inotropes and mortality of patients after coronary artery bypass surgery.

Materials and Methods: The cross-sectional study was conducted on 100 files of patients undergoing coronary artery bypass surgery at Shahid Chamran Hospital, Isfahan during the years 1400-1403. These patients were divided into two groups of 50 and injected cardioplegia solution by two methods: retrograde-antegrade and antegrade alone. Then, the need for inotrope, the need for intra-aortic balloon pump(IABP), and the patient's outcome(death or live) were assessed and recorded.

Results: The results of the present study showed that the need for inotrope in the combined antegrade-retrograde solution injection group and antegrade alone were 8% and 10%, respectively, with no statistically significant difference between the two groups(P = 0.727). In addition, none of the patients requiring IABP, and only one patient died in the antegrade cardioplegia solution injection group(P = 0.315).

Conclusion: According to the results of current study, although the need for inotrope in the combined retrograde-antegrade method was less than the antegrade method alone, there was no significant difference between the two methods of cardioplegia solution injection in terms of inotrope need and outcome of patients undergoing CABG surgery.

Highlights

Alireza Hosseini: Google Scholar, PubMed

Mehran Shahzamani:Google Scholar, PubMed

Asieh Maghami-Mehr:Google Scholar, PubMed

Keywords
Coronary Artery Bypass Grafts
Cardioplegia Solution
Retrograde
Antegrade
Inotrope
Mortality

Subjects

1.     Shaefi S, Mittel A, Loberman D, Ramakrishna H. Off-Pump versus on-pump coronary artery bypass grafting-a systematic review and analysis of clinical outcomes. J Cardiothorac Vasc Anesth. 2019; 33(1): 232-44.
2.     Sheikhy A, Fallahzadeh A, Forouzannia K, Pashang M, Tajdini M, Momtahen S, et al. Off-pump versus on-pump coronary artery bypass graft surgery outcomes in patients with severe left ventricle dysfunction: inverse probability weighted study. BMC Cardiovasc Disord. 2022; 22(1): 488.
3.     Koohi F, Salehiniya H, Mohammadian Hafshejani A. Trends in mortality from cardiovascular disease in Iran from 2006-2010 [in Persian]. J Sabzevar Univ Med Sci 2015; 22(4): 630-8.
4.     Liu D, Liu B, Liang Z, Yang Z, Ma F, Yang Y, et al. Acute kidney injury following cardiopulmonary bypass: a challenging picture. Oxid Med Cell Longev 2021; 2021: 8873581.
5.     Khalili A, Rahimi M, Khezerlouy-Aghadam N, Akbarzadeh F, Taban-Sadeghi M. In-hospital mortality of patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting in Iranian population. J Cardiothorac Surg. 2022; 17(1): 162.
6.     Park SU, Bae YH, Kim YS, Song K, Jang WS. Surgical results of only antegrade del Nido cardioplegia infusion in conventional coronary artery bypass grafting: a retrospective study. J Yeungnam Med Sci 2023; 40(Suppl): S23-S28.
7.     Gori T. Coronary venous therapy to improve microvascular dysfunction. Clin Hemo Micro 2021; 79(1): 103-7.
8.     Radmehr H, Soleimani A, Tatari H, Salehi M. Does combined antegrade-retrograde cardioplegia have any superiority over antegrade cardioplegia? Heart Lung Circ 2008; 17(6): 475-7.
9.     Tian G, Xiang B, Dai G, Li G, Sun J, Summers R, Deslauriers R. Retrograde cardioplegia. J Thorac Cardiovasc Surg 2003; 125 (4): 872-80.
10.  Jabeen S, Arif A, Bukhari SR, Umair M, Akbar S, Yunus A. Correlation of Post-Operative Outcomes in patients undergoing CABG Receiving Antegradecardioplegia alone Versus Combined Antegrade Plus Retrograde Cardioplegia: A Prospective Review. Pakistan Journal of Medical & Health Sciences. 2023; 17(04): 156-160.
11.  Wahba M, Sultan A, Awadalla K. Antegrade versus Retrograde Blood Cardioplegia in Left Main Coronary Artery Disease Patients Underwent CABG. Egyptian Journal of Hospital Medicine 2024; 95: 2219-24.
12.  Prabhu NV, Maiya AG, Prabhu NS. Impact of cardiac rehabilitation on functional capacity and physical activity after coronary revascularization: a scientific review. Cardiol Res Pract 2020; 2020(1): 1236968.
13.  Bradić J, Andjić M, Novaković J, Jeremić N, Jakovljević V. Cardioplegia in open heart surgery: age matters. Journal of Clin Med 2023; 12(4): 1698.
14.  Ascione R, Caputo M, Gomes WJ, Lotto AA, Bryan AJ, Angelini GD, et al. Myocardial injury in hypertrophic hearts of patients undergoing aortic valve surgery using cold or warm blood cardioplegia. Eur J Cardiothorac Surg 2002; 21: 440–6.
15.  Tokmakoğlu H, Kandemir O, Yorgancıoğlu  C, Zorlutuna Y. Antegrade versus Antegrade/ retrograde cardioplegia for myocardial protection in patients undergoing coronary artery bypass grafting. Marmara Medical Journal 2001; 14(3): 154-159.
16.  Amaç B, Bağış MZ. Comparison Of Antegrade And Antegrade/Retrograde Blood Cardioplegia Applications In Cardiopulmonary Bypass Accompanıed Cardiac Surgery. Abant Med J 2024; 13(1): 16-23.
17.  2Uğur O, Kalender M, Gökmengil H, Bingöl H. Does combined antegrade and selective coronary graft cardioplegia reduce conduction defects in right coronary artery occluded patients?. J Sur Med 2018; 2(1): 1-5.
18.  Kesieme EB, Buchan KG. Clinical anatomy of the coronary venous system and relevance to retrograde cardioplegia and cardiac electrophysiological interventions. Clin Anat 2025; 38(1): 43-53.
19.  Abdelwahhab AI, Mohamed E, Khairy M, Elminshawy A. Results of Combined Antegrade and Retrograde Versus Antegrade Cardioplegia in Complex Coronary Artery Bypass Surgeries. Frontiers in Health Informatics 2024; 13(6): 1036-43.
20.  Field ML, Rengarajan A, Khan O, Spyt T, Richens D. Preoperative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev. 2007;(1): CD004472.
21.  Baig MA, Sher-I-Murtaza M, Iqbal A, Ahmad MZ, Farhan Ali Rizvi HM, Ahmed N, Shair A, Ijaz A. Clinical outcomes of intermittent antegrade warm versus cold blood cardioplegia. J Pak Med Assoc 2015; 65(6): 593-6.
22.  Martins AS, Silva MA, Padovani CR, Matsubara BB, Braile DM, Catâneo AJ. Myocardial protection by continuous, blood, antegrade-retrograde cardioplegia in rabbits. Acta Cir Bras. 2007; 22(1): 43-6.
23.  Al-Jughiman M, Algarni K, Yau T. Outcomes of isolated reoperative coronary artery bypass grafting in elderly patients. J Card Surg 2015; 30(1): 41-6.
Journal of Isfahan Medical School
Volume 43, Issue 847
3rd Week, March
March and April 2026
Pages 1995-2001

  • Receive Date 05 January 2025
  • Accept Date 10 December 2025