Retrograde versus antegrade crystalloid cardioplegia in coronary surgery: value of troponin-I measurement

• Published in: The Annals of thoracic surgery Vol. 71; no. 1; pp. 249 - 253
• Main Authors: Franke, Ulrich, Wahlers, Thorsten, Cohnert, Tina U, Koenig, Jasper, Rath, Norbert F, Wirsing, Michaela, Haverich, Axel
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2001; Elsevier Science
• Subjects: Aged; Biological and medical sciences; Coronary Artery Bypass; Creatine Kinase - blood; Creatine Kinase, MB Form; Female; Heart Arrest, Induced - methods; Humans; Isoenzymes - blood; Male; Medical sciences; Middle Aged; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Troponin I - blood; Human; Enzyme; Creatine kinase; Transferases; Retrograde; Biological marker; Cardioplegia; Exploration; Troponin; Enzymatic activity; Aortocoronary; Crystalloid solution; Bypass; Surgery; Anterograde; Graft; Comparative study
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(00)02145-7

Background. The optimal route for delivery of cardioplegia is still in debate in patients with ischemic heart disease. Cardiac troponin-I is a new marker with the potential for detection of minor differences in myocardial ischemia. Methods. In a prospective randomized trial 58 patients undergoing elective coronary artery bypass grafting for two- or three-vessel coronary artery disease were divided into groups with antegrade (group A, n = 29) and retrograde (group R, n = 29) application of crystalloid cardioplegia (St. Thomas II). Patients with major risk factors were excluded. In addition to routine electrocardiogram monitoring, cardiac troponin-I and creatine kinase-MB activity were measured in all patients preoperatively at 2, 5, 8, 24, and 48 hours after aortic cross-clamp release, and at hospital discharge. Results. In both groups, there were no differences regarding operative parameters. A significantly higher cardiac troponin-I concentration was observed in the antegrade group at 24 hours after cross-clamp (8.2 ± 8.5 μg/L vs 3.2 ± 3.1 μg/L; p = 0.02). Patients with subtotal stenosis or occlusion of one or more main coronary arteries showed significantly lower cardiac troponin-I levels after retrograde application. Conclusions. Lower concentrations of the cardiac troponin-I marker after retrograde application of cardioplegia indicate advantages of myocardial protection in ischemic heart disease.