Does Combination of Antegrade and Retrograde Cardioplegia Reduce Coronary Artery Bypass Grafting-Related Conduction Defects?


  • Cengiz Bolcal
  • Bilgin Emrecan
  • Hakan Bingöl
  • Mehmet Fatih Ayik
  • Faruk Cingöz
  • Vedat Yildirim
  • Erkan Kuralay
  • Ufuk Demirkiliç
  • Selim Kiliç
  • Harun Tatar



Background. Conduction disorders appearing after coronary artery bypass surgery (CABG) may have many different causes. In this study, we evaluated the postoperative conduction disorders after CABG with respect to the ante-grade blood cardioplegia and ante-grade plus continuous retrograde cardioplegia delivery methods.

Materials and Methods. This retrospective study included 1824 patients undergoing CABG between January 2001 and December 2005. There were 694 female patients (38%) and 1130 male patients (62%). Myocardial protection was done by isothermic hyperkalemic blood cardioplegia. Patents in Group 1 (n = 704) were operated on using only intermittent antegrade cardioplegia and those in group 2 (n = 1120) were operated on using the antegrade plus retrograde continuous cardioplegia. The postoperative occurrences of a new right bundle branch block, left anterior hemiblock, left posterior hemiblock, left bundle branch block, or third-degree atrioventricular block were evaluated and compared.

Results. Total mortality rate was 1.6% (29 patients) without significant difference between the groups. The preoperative and perioperative characteristics were statistically similar in the groups. The occurrence of conduction disorders was significantly higher in group 1 (P = .006, 55 versus 52 patients). The analysis of the patients with conduction disorders showed a significantly increased mortality rate (P < .001) in addition to a significantly increased period of intensive care unit follow-up and duration of postoperative hospitalization (P <.001).

Conclusion. The present study demonstrated that the perioperative occurrence of conduction disorders after CABG was decreased by antegrade controlled and retrograde continuous combination cardioplegia.


Badak MI, Gurcun U, Discigil B, Boga M, Ozkisacik EA, Alayunt EA. 2005. Myocardium utilizes more oxygen and glucose during tepid blood cardioplegic infusion in arrested heart. Int Heart J 46:219-29.nCaretta Q, Mercanti C, DeNardo D, et al. 1991. Ventricular conduction defects and atrial fibrillation after coronary artery bypass grafting. Multi-variate analysis of preoperative, intraoperative and postoperative variables. Eur Heart J 12:1107-11.nCaspi J, Ammar R, Elami A, Safadi T, Merin G. 1989. Frequency and significance of complete atrioventricular block after coronary artery bypass grafting. Am J Cardiol 63:526-9.nCaspi Y, Safadi T, Ammar R, Elamy A, Fishman NH, Merin G. 1987. The significance of bundle branch block in the immediate postoperative electrocardiograms of patients undergoing coronary artery bypass. J Thorac Cardiovasc Surg 93:442-6.nFlack J, Hafer J, Engelman R, Rousou J, Deaton D, Pekow P. 1992. Effect of normothermic blood cardioplegia on postoperative conduction abnormalities and supreventricular arrhythmias. Circulation 86(suppl II):II385-92.nGundry S, Sequeira A, Coughlin T, McLaughlin J. 1989. Postoperative conduction disturbances: a comparison of blood and crystalloid cardioplegia. Ann Thorac Surg 47:38-90.nHake U, Iversen S, Erbel R, et al. 1990. New bundle branch block after coronary bypass grafting: evaluation by CK-MB isoenzyme analysis and transesophageal echocardiography. Eur Heart J 11:59-64.nHayashida N, Weisel RD, Shirai T, et al. 1995. Tepid antegrade and retrograde cardioplegia. Ann Thorac Surg 59:723-9.nMosseri M, Meir G, Lotan C, et al. 1991. Coronary pathology predicts conduction disturbances after coronary artery bypass grafting. Ann Thorac Surg 51:248-52.nMustonen P, Hippelainen M, Rehnberg S. 1995. Low myocardial temperatures are associated with postoperative conduction defects after coronary artery bypass surgery. Ann Chir Gynaecol 84:44-50.nMustonen P, Hippelainen M, Vanninen E, Rehnberg S, Tenhunen-Eskelinen M, Hartikainen J. 1998. Significance of coronary artery bypass grafting associated conduction defects. Am J Cardiol 81:558-63.nPattison C, Dimitri W, Williams B. 1991. Persistent conduction disturbances following coronary artery bypass surgery: cold cardioplegic vs. intermittent ischaemic arrest (32 degrees C). Scand J Thorac Cardiovasc Surg 25:151-4.nPehkonen EJ, Honkonen EL, Makynen PJ, Kataja MJ, Tarkka MR. 1996. Conduction disturbances after different blood cardioplegia modes in coronary artery bypass grafting. Including comparison with an earlier patient series. Scand J Thorac Cardiovasc Surg 30:149-55.nSeitelberger R, Wild T, Serbecic N, et al. 2000. Significance of right bundle branch block in the diagnosis of myocardial ischemia in patients undergoing coronary artery bypass grafting. Eur J Cardiothorac Surg 18:187-93.nTuzcu EM, Emre A, Goormastic M, Loop FD, Underwood DA. 1990. Incidence and prognostic significance of intraventricular conduction abnormalities after coronary bypass surgery. J Am Coll Cardiol 16:607-10.nUeyama K, Jones JW, Ramchandani M, Beall AC, Thornby JI. 1997. Clinical variables influencing the appearance of right bundle branch block after cardiac surgery. Cardiovasc Surg 5:574-8.nWexelman W, Lichstein E, Cunningham JN, Hollander G, Greengart A, Shani J. 1986. Etiology and clinical significance of new fascicular conduction defects following coronary bypass surgery. Am Heart J 111:923-7.nWillems J, Robles de Medina E, Bernard R, et al. 1985. Criteria for intraventricular conduction disturbances and pre-excitation. World Health Organizational/International Society and Federation for Cardiology Task Force Ad Hoc. J Am Coll Cardiol 5:1261-75.n



How to Cite

Bolcal, C., Emrecan, B., Bingöl, H., Ayik, M. F., Cingöz, F., Yildirim, V., Kuralay, E., Demirkiliç, U., Kiliç, S., & Tatar, H. (2006). Does Combination of Antegrade and Retrograde Cardioplegia Reduce Coronary Artery Bypass Grafting-Related Conduction Defects?. The Heart Surgery Forum, 9(6), E866-E870.