The role of retrograde coronary sinus perfusion in the preservation of ischemic myocardium is controversial. We evaluated the use of combined antegrade and retrograde
cardioplegia in 59 patients undergoing
coronary artery bypass surgery. Nineteen patients were administered antegrade
cardioplegia, whereas 40 patients were administered antegrade plus retrograde
cardioplegia. Hemodynamic data were obtained before the onset of
cardiopulmonary bypass and at 1, 2, 4, 8, 16, and 24 hours after cessation of
cardiopulmonary bypass. Myocardial function was assessed by measuring systemic blood pressure, heart rate, cardiac index, pulmonary artery pressure, and capillary wedge pressure. Both cohorts were similar in age, incidence of
hypertension, diabetes, and previous
myocardial infarction. No significant differences were noted in the need for postoperative inotropic support, the incidence of postoperative arrhythmias,
myocardial infarction,
heart block, or death. The two groups were similar with respect to cardiac index and systemic and pulmonary vascular resistance. However, the left ventricular
stroke work index, when expressed as a function of its prebypass control value, was significantly improved (p less than 0.01) in the cohort administered combined
cardioplegia. In the combined group recovery of left ventricular
stroke work index occurred earlier and was more complete. These results suggest that the use of combined antegrade/retrograde
cardioplegia is safe and may provide superior protection.