Selective Vein Graft Cold Cardioplegia and Warm Reperfusion to Enhance Early Recovery in Patients with Left Ventricle Depression Undergoing Coronary Artery Surgery
<b>Background:</b> Antegrade root cardioplegia remains the most popular strategy for myocardial protection during coronary artery bypass graft (CABG) performed with cardiopulmonary bypass (CPB) and aortic cross clamp. In patients with depressed left ventricular function, however, especia...
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2025-06-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/12/6/222 |
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| author | Pasquale Totaro Martina Musto Eduardo Tulumello Antonella Degani Vincenzo Argano Stefano Pelenghi |
| author_facet | Pasquale Totaro Martina Musto Eduardo Tulumello Antonella Degani Vincenzo Argano Stefano Pelenghi |
| author_sort | Pasquale Totaro |
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| description | <b>Background:</b> Antegrade root cardioplegia remains the most popular strategy for myocardial protection during coronary artery bypass graft (CABG) performed with cardiopulmonary bypass (CPB) and aortic cross clamp. In patients with depressed left ventricular function, however, especially if associated with severe multiple coronary stenosis, increased pharmacological and/or mechanical support in the early post-CPB period is often required to support left ventricular recovery. In this study, we analyzed the results of a myocardial protection strategy that includes selective infusion of cardioplegia through each venous graft followed by warm reperfusion distal to each coronary anastomosis until complete removal of the aortic clamp (total antegrade cardioplegia infusion and warm reperfusion = TAWR) to improve early postoperative recovery in patients with depressed left ventricular function undergoing multi-vessel CABG. <b>Methods:</b> Out of 97 patients undergoing CABG using the TAWR strategy for myocardial protection, 32 patients presented with depressed left ventricle function (EF < 40%) and multi-vessel coronary diseases requiring ≥2 vein grafts and were enrolled as Group A. Combined primary outcomes and postoperative early and late left ventricle recovery (including spontaneous rhythm recovery, inotropic support and postoperative troponin release) were analyzed and compared with those of 32 matched patients operated on using standard antegrade root cardioplegia and limited warm reperfusion through LIMA graft (SAWR) enrolled as Group B. <b>Results:</b> Two patient died in hospital (in-hospital mortality 3.1%) with no statistical differences between the two groups. In Group A 27 patients (90%) had spontaneous recovery of idiopathic rhythm compared to 17 (53%) in group B (<i>p</i> = 0.001). Early inotropic support was required in nine patients (28%) of group A and seventeen patients (53%) of group B (<i>p</i> = 0.041). Furthermore, in eight patients (25%) of group A and seventeen (53%) of group B (<i>p</i> = 0.039) inotropic support was continued for >48 h. <b>Conclusions</b>: The TAWR strategy seems to significantly improve early postoperative cardiac recovery in patients with left ventricle depression undergoing multi-vessel CABG, when compared with SAWR strategy and could therefore be considered the strategy of choice in this subset of patients. |
| format | Article |
| id | doaj-art-2606975f99aa4c3bb8e95d25b368339b |
| institution | OA Journals |
| issn | 2308-3425 |
| language | English |
| publishDate | 2025-06-01 |
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| spelling | doaj-art-2606975f99aa4c3bb8e95d25b368339b2025-08-20T02:21:13ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252025-06-0112622210.3390/jcdd12060222Selective Vein Graft Cold Cardioplegia and Warm Reperfusion to Enhance Early Recovery in Patients with Left Ventricle Depression Undergoing Coronary Artery SurgeryPasquale Totaro0Martina Musto1Eduardo Tulumello2Antonella Degani3Vincenzo Argano4Stefano Pelenghi5Cardiac Surgery, IRCCS Foundation Hospital San Matteo, 27100 Pavia, ItalyCardiac Surgery, IRCCS Foundation Hospital San Matteo, 27100 Pavia, ItalyCardiac Surgery, University Hospital P Giaccone, 90127 Palermo, ItalyCardiac Surgery, IRCCS Foundation Hospital San Matteo, 27100 Pavia, ItalyCardiac Surgery, University Hospital P Giaccone, 90127 Palermo, ItalyCardiac Surgery, IRCCS Foundation Hospital San Matteo, 27100 Pavia, Italy<b>Background:</b> Antegrade root cardioplegia remains the most popular strategy for myocardial protection during coronary artery bypass graft (CABG) performed with cardiopulmonary bypass (CPB) and aortic cross clamp. In patients with depressed left ventricular function, however, especially if associated with severe multiple coronary stenosis, increased pharmacological and/or mechanical support in the early post-CPB period is often required to support left ventricular recovery. In this study, we analyzed the results of a myocardial protection strategy that includes selective infusion of cardioplegia through each venous graft followed by warm reperfusion distal to each coronary anastomosis until complete removal of the aortic clamp (total antegrade cardioplegia infusion and warm reperfusion = TAWR) to improve early postoperative recovery in patients with depressed left ventricular function undergoing multi-vessel CABG. <b>Methods:</b> Out of 97 patients undergoing CABG using the TAWR strategy for myocardial protection, 32 patients presented with depressed left ventricle function (EF < 40%) and multi-vessel coronary diseases requiring ≥2 vein grafts and were enrolled as Group A. Combined primary outcomes and postoperative early and late left ventricle recovery (including spontaneous rhythm recovery, inotropic support and postoperative troponin release) were analyzed and compared with those of 32 matched patients operated on using standard antegrade root cardioplegia and limited warm reperfusion through LIMA graft (SAWR) enrolled as Group B. <b>Results:</b> Two patient died in hospital (in-hospital mortality 3.1%) with no statistical differences between the two groups. In Group A 27 patients (90%) had spontaneous recovery of idiopathic rhythm compared to 17 (53%) in group B (<i>p</i> = 0.001). Early inotropic support was required in nine patients (28%) of group A and seventeen patients (53%) of group B (<i>p</i> = 0.041). Furthermore, in eight patients (25%) of group A and seventeen (53%) of group B (<i>p</i> = 0.039) inotropic support was continued for >48 h. <b>Conclusions</b>: The TAWR strategy seems to significantly improve early postoperative cardiac recovery in patients with left ventricle depression undergoing multi-vessel CABG, when compared with SAWR strategy and could therefore be considered the strategy of choice in this subset of patients.https://www.mdpi.com/2308-3425/12/6/222myocardial ischemiacoronary arterybypass aorto-coronarycardioplegiamyocardial protection |
| spellingShingle | Pasquale Totaro Martina Musto Eduardo Tulumello Antonella Degani Vincenzo Argano Stefano Pelenghi Selective Vein Graft Cold Cardioplegia and Warm Reperfusion to Enhance Early Recovery in Patients with Left Ventricle Depression Undergoing Coronary Artery Surgery Journal of Cardiovascular Development and Disease myocardial ischemia coronary artery bypass aorto-coronary cardioplegia myocardial protection |
| title | Selective Vein Graft Cold Cardioplegia and Warm Reperfusion to Enhance Early Recovery in Patients with Left Ventricle Depression Undergoing Coronary Artery Surgery |
| title_full | Selective Vein Graft Cold Cardioplegia and Warm Reperfusion to Enhance Early Recovery in Patients with Left Ventricle Depression Undergoing Coronary Artery Surgery |
| title_fullStr | Selective Vein Graft Cold Cardioplegia and Warm Reperfusion to Enhance Early Recovery in Patients with Left Ventricle Depression Undergoing Coronary Artery Surgery |
| title_full_unstemmed | Selective Vein Graft Cold Cardioplegia and Warm Reperfusion to Enhance Early Recovery in Patients with Left Ventricle Depression Undergoing Coronary Artery Surgery |
| title_short | Selective Vein Graft Cold Cardioplegia and Warm Reperfusion to Enhance Early Recovery in Patients with Left Ventricle Depression Undergoing Coronary Artery Surgery |
| title_sort | selective vein graft cold cardioplegia and warm reperfusion to enhance early recovery in patients with left ventricle depression undergoing coronary artery surgery |
| topic | myocardial ischemia coronary artery bypass aorto-coronary cardioplegia myocardial protection |
| url | https://www.mdpi.com/2308-3425/12/6/222 |
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