Antegrade and Retrograde Versurs Antegrade Cardioplegia in Complex Coronary Artery Bypass Surgeries
Antegrade and Retrograde Versurs Antegrade Cardioplegia in Complex Coronary Artery Bypass Surgeries
During coronary artery bypass surgery, myocardial protection, especially of the right
 ventricle, may be inadequate in the presence of severe coronary lesions that obstruct the
 antegrade delivery of cold cardioplegia
Asymetric myocardial cooling has been reported to yield postoperative right ventricular
 dysfunction, which may contribute to postoperative morbidity and mortality. Retrograde
 coronary sinus perfusion was introduced in 1956 to facilitate surgery involving the aortic
 valve. This technique was introduced as a means of myocardial protection for coronary artery
 bypass surgery in 1967 and has recently received renewed interest. An innovative method of
 delivering retrograde cardioplegia through the right atrium was recently developed by Fabiani
 and associates. This technique has obviated the need to directly cannulate the coronary sinus
 and thus has eliminated concerns regarding coronary sinus rupture due to cannulation, and
 concerns of inadequate right ventricular perfusion. In contrast to antegrade delivery,
 retrograde delivery of cardioplegia through the right atrium is not subject to the problem of
 limited distribution in the presence of coronary artery occlusive disease and thus allows
 more uniform cooling of the left ventricle,so the study will compare the results of combined
 antegrade and retrograde versurs antegrade cardioplegia in complex coronary artery bypass
 surgeries
Inclusion Criteria:

 -  Age between 18 and 60 years

 -  LV ejection fraction between 30 and 50%

 -  left main stem CAD

 -  mitral or aortic valve disease associated with ischemic heart disease

 Exclusion Criteria:

 -  Double valve disease or other valve disease

 -  mitral or aortic valve disease associated with congenital heart disease

 -  patients subjected to prior heart surgery

 -  emergency operation

 -  poorly controlled diabetes mellitus