Comparison of Post-Operative Enzymes in Antegrade versus Combined Antegrade-Retrograde Cardioplegia in Elective Coronary Artery Bypass Graft Surgery

Abstract

Objectives: Cardiac enzyme levels, such as troponin I, are important markers of myocardial injury after coronary artery bypass graft (CABG) surgery. This study was planned to compare post-operative cardiac enzymes (troponin level) in antegrade vs. combined antegrade-retrograde cardioplegia in patients undergoing elective coronary artery bypass graft surgery. Methodology: We included patients aged between 30 and 75 years, of either sex who were approved for coronary artery bypass graft surgery. Baseline and post-operative cardiac enzyme level were measured at 4 and 12 hours and compared between the antegrade vs. combined antegrade-retrograde St.Thomas cardioplegia groups. Results: The study included 60 participants, 75% (45) of them male, having average age 59.7±12.1 years. A majority of patients (55%, n=33) underwent triple-vessel grafting. Hypertension was present in 58.3% (35), smoking history was positive in 45% (27), and diabetes mellitus in 43.3% (26). The mean cardioplegia time was 64.3±10.6 minutes, and the overall procedure duration averaged 247.2±69.6 minutes. Trop I in antegrade cardioplegia and antegrade plus retrograde cardioplegia at 4th and 12th post-operative hour were 0.49 ± 0.25 vs. 0.45 ± 0.2 ng/mL; p=0.531 and 0.8 ± 0.25 vs. 0.3 ± 0.11 ng/mL; p<0.001, respectively. Conclusion: Antegrade-retrograde cardioplegia strategy was associated with lower Troponin-I levels at 12 postoperative hours, suggesting it a better strategy for protecting the heart in CABG.