Coronary Artery Bypass Surgery Using Retrograde Cardioplegics

Moon, Hyeon Jong; Kim, Ki Bong; Rho, Joon Ryang

Abstract

Retrograde myocardial protection is widely accepted in CABG operation because of the limitations of the antegrade method in the coronary arterial stenosis lesions. We analyzed 76 cases of retrograde myocardial protection among 96 cases of CABG operation performed between April 1994 and August 1995. There were 48 males and 28 females, and the mean age was 58.2+/-8.3 years. 53 patients(70%) were operated for unstable angina, 14(18%) for stable angina, 6(8%) for post-infarct angina, 1(1%) for acute myocardial infarction, and 2(3%) for failed PTCA. Preoperative coronary angiography revealed 3-vessel disease in 42 cases, 2-vessel disease in 11, 1-vessel disease in 10, and left main disease in 13 cases. We used SVG(63 cases), LIMA(69 cases), RIMA(11 cases), radial artery(6 cases), and gastroepiploic artery(1 case) for the grafts. Mean anastomosis was 3.2+/-1.1. We protected the myocardium with antegrade induction and retrograde maintenance in all the cases except a case of retrograde induction and maintenance. During the aortic cross-clamping, blood cardioplegia was administered intermittently in 19 cases, and continuously in 57. In 39 cases, we used retrograde cardioplegia and antegrade perfusion of RCA graft simultaneously. We had no operative motality. Perioperative complications were arrhythmia in 15 cases, perioperatve myocardial infarction in 10, low cardiac output syndrome in 8, transient neurologic problem in 7, transient psychiatric problem in 6, ARF in 3, bleeding in 2, pneumonia in 2, wound infection in 1, and duodenal ulcer perforation in 1. In this report, we experienced 76 cases of CABG operation with retrograde myocardial protection under the acceptable operative risk without operative mortality.