Journal of Yeungnam Medical Science

Original article

Surgical results of only antegrade del Nido cardioplegia infusion in conventional coronary artery bypass grafting: a retrospective study: Sang-Uk Park, Yo Han Bae, Yun Seok Kim, Kyungsub Song, Woo Sung Jang; J Yeungnam Med Sci. 2023;40(Suppl):S23-S28. Published online June 28, 2023; DOI: https://doi.org/10.12701/jyms.2023.00283

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Abstract PDF: Background
Additional retrograde cardioplegia infusion in conventional coronary artery bypass grafting (CABG) was introduced to address the concern of inappropriate cardioplegia delivery through the stenotic coronary artery. However, this method is complex and requires repeated infusions. Therefore, we investigated the surgical outcomes of only antegrade cardioplegia infusion in conventional CABG.
Methods
We included 224 patients who underwent isolated CABG between 2017 and 2019. The patients were divided into two groups according to the cardioplegia infusion method: antegrade cardioplegia infusion with del Nido solution (n=111, group I) and antegrade+retrograde cardioplegia infusion with blood cardioplegia solution (n=113, group II).
Results
The sinus recovery time after release of the aorta cross-clamp was shorter in group I (3.8±7.1 minutes, n=98) than in group II (5.8±4.1 minutes, n=73) (p=0.033). The total cardioplegia infusion volume was lower in group I (1,998.6±668.6 mL) than in group II (7,321.0±2,865.3 mL) (p<0.001). Creatine kinase-MB levels were significantly lower in group I than in group II (p=0.039). Newly developed regional wall motion abnormalities on follow-up echocardiography were detected in two patients (1.8%) in group I and five patients (4.4%) in group II (p=0.233). There was no significant difference in ejection fraction improvement between the two groups (3.3%±9.3% in group I and 3.3%±8.7% in group II, p=0.990).
Conclusion
The only antegrade cardioplegia infusion strategy in conventional CABG is safe and has no harmful effects.

Review Article

Hybrid Coronary Revascularization: Sung Sae Han; Yeungnam Univ J Med. 2007;24(2 Suppl):S36-48. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S36

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Abstract PDF: Hybrid coronary revascularization combines left internal mammary artery (LIMA) to left anterior descending artery (LAD) grafting integrated with percutaneous coronary intervention (PCI) on stenoses in the non-LAD territories. Hybrid coronary revascularization offers multivessel revascularization with minimal morbidity in high risk patients. Usually hybrid coronary revascularization performs minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass. The concept is now 10 year old. This procedure has been developed from MIDCAB plus percutaneous transluminal coronary angioplasty (PTCA) to totally endoscopic coronary artery bypass grafting (TECAB) procedures plus PTCA and drug-eluting stenting (DES). The hybrid coronary revascularization procedure may be especially useful in complex LAD lesions, restenotic lesions in LAD, acute myocardial infarction in “non-LAD” territory, high-risk elderly patients with multiple comorbidities and patients with severe left ventricular systolic dysfunction who are not ideal candidates for conventional bypass surgery. Hybrid coronary revascularization results according to the literature are very attractive. LIMA patency rates were found to be in the 98% range and restenosis rates in the PCI part of the procedure are in a 12% range.¹⁶⁾ The wider introduction of hybrid revascularization is limited chiefly by the high number of repeat interventions compared with off-pump coronary artery bypass grafting, which occurs because of the target vessel failure rate of percutaneous coronary intervention. Drug-eluting stents substantially decrease the reintervention rate. However, the future role of hybrid coronary revascularization is unclear in patients with multivessel coronary artery disease involving the LAD if comparable results may be attained with multivessel PCI.

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