Homogeneous delivery of cardioplegia is an important component of myocardial protection in any patient who undergoes open heart surgery and poorly protected myocardial segments may have decreased function following ischemia. It has been shown that inhomogeneous cardioplegic delivery results in impaired regional and global left ventricular (LV) systolic function, as well as impaired diastolic function. Antegrade delivery of cardioplegia via the aortic root is a common cardioplegic delivery technique while it could result in an inhomogeneous perfusion of myocardium in some kind of cardiac surgery. Retrograde cardioplegia via the coronary sinus is another way of myocardial protection which may provide better protection of myocardium in such patients.
Some studies have shown that warm antegrade cardioplegia results in better left ventricular perfusion than warm retrograde cardioplegia while some others are on this supposition that retrograde application of cardioplegia is more advantageous. Because of important affects of cardioplegia on patients outcome, a great need exists to find the differences between retrograde and anterograde cardioplegia with new methods. Therefore, we are on this supposition that measuring ischemic and inflammatory biomarkers in coronary sinus blood sample before, during, and after cardiopulmonary bypass would provide us with more valuable information.
100 patients from Dr.Ghavidel surgery service who meet the inclusion criteria at Rajaee heart center are included in this single blinded randomized clinical trial. All patients are first time candidates for cardiac surgery. They will be randomized into two equal groups with Random number table method of randomization.
Procedure:
Routin antrograde will be done in control group and routin anterograde-retrograde cardioplegia will be done in treatment group. Further details are mentioned below.
Coronary Sinus Sampling:
To determine the effects on myocardial stress, blood samples are taken from the retrograde coronary sinus catheter (before institution of CPB, On removal of aortic cross-clamp, 30 minutes after weaning from CPB) for interleukin (IL)-6, IL-18, and tumor necrosis factor (TNF)-alpha, Na, K, Ca, Lactate, pyruvate and LP (Lactate Pyruvate) ratio, cTnI, sICAM-1, sVCAM-1, Lactate dehydrogenase, high sensitivity C-reactive protein (hsCRP), PH, and HCO3 levels. Serum samples were also analyzed to measure these biomarkers as well (before institution of CPB, on removal of aortic cross-clamp, 30 minutes, and 12 hours after completion of CPB).