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Ann Thorac Surg 2001;71:249-253
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

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

Ulrich Franke, MDa, Thorsten Wahlers, MDa, Tina U. Cohnert, MDa, Jasper Koenig, MDb, Norbert F. Rath, MDb, Michaela Wirsing, MDb, Axel Haverich, MDb

a Department of Thoracic and Cardiovascular Surgery, Medical School, Hannover, Germany
b Department of Clinical Chemistry II, Medical School, Hannover, Germany

Accepted for publication May 10, 2000.

Address reprint requests to Dr Franke, Klinik für Herz-, Thorax-und Gefäß Chirurgie, Friedrich-Schiller-Universität, Postfach, D-07740 Jena, Germany
e-mail: ulrich.franke{at}med.uni-jena.de

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.




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