[Myocardial protection: antegrade cardioplegia versus mixed cardioplegia (with right atrial perfusion) in high risk elective coronary surgery. A prospective trial]. / Protección miocárdica: cardioplejía anterógrada frente a cardioplejía mixta (con infusión en aurícula derecha) en cirugía coronaria electiva de alto riesgo. Estudio prospectivo aleatorio.

ABSTRACT

INTRODUCTION: It is unclear after review the literature, whether the techniques of retrograde cardioplegia provides more optimal myocardial protection in the setting of coronary surgery that is possible with conventional antegrade cardioplegia, due to inhomogeneous patient subset that appears in clinical trials. PATIENTS AND METHODS: The present clinical study, prospective and randomized was undertaken in 40 patients undergoing high risk myocardial revascularization to compare the efficacy of both techniques. Inclusion criterias were age > 65 years, unstable angor, multivessel disease and impaired ventricular function. One control group received cardioplegia through the aortic root, and the study group received combined antegrade-retrograde cardioplegia with perfusion into the right atrium. In both groups the vehicle of cardioplegia was oxygenated blood. RESULTS: There were 3 deaths, two in the control group and another one in the study group. Overall operative mortality was 7.3%. Left main coronary stenosis was present in the 2 patients dying in the control group. There were no significant differences between the two groups with regard to the operative and postoperative parameters analyzed; trials to wean off cardiopulmonary bypass, inotropic support, intra-aortic balloon counterpulsation, perioperative myocardial infarction, and levels of myocardial enzymes. There were higher incidence of temporal heart block in patients in study group. CONCLUSIONS: It was difficult to identify any appreciable difference in the clinical efficacy of these two methods of myocardial protection. We review the literature, trying to identify the "better" alternative in the setting of coronary revascularization and different patient subset.