The effect of cardioplegia techniques on left ventricular functions in coronary artery bypass grafting: A comparison with tissue Doppler echocardiography

Objectives: This study aims to evaluate the effects of antegrade cardioplegia (ACP) and combined antegrade/retrograde cardioplegia (ARCP) on left ventricular systolic and diastolic function in patients undergoing elective coronary artery bypass grafting (CABG) using tissue Doppler echocardiography (TDE). Patients and methods: Between September 2010 and September 2012, a total of 40 patients (29 males, 11 females; mean age: 62±1.45 years; range, 27 to 78 years) who underwent elective isolated CABG under cardiopulmonary bypass were included. The patients were equally divided into two groups (n=20). Group 1: Antegrade cold blood cardioplegia (0-6°C), Group 2: Antegrade + retrograde cold blood cardioplegia (0-6°C). The TDE was performed preoperatively and was repeated at Weeks 1 and 4 postoperatively. Isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT), ejection time (ET), mitral annular waves, and diastolic velocity/myocardial E velocity (E/Em), late diastolic velocity (A) ratios were measured using TDE. The Tei index was calculated to assess the global function. Results: The transmitral (E), E/A ratio, ejection fraction (EF), IVRT, IVCT, and myocardial performance index (MPI) significantly increased, whereas the transmitral (A), E wave deceleration time (EDT), and ET decreased. In the ARCP group, (E), the E/A ratio, EF, IVRT, IVCT, and MPI increased and ET decreased; however, (A) and EDT did not change. Both groups showed an improvement in cardiac function after revascularization. Conclusion: Our study results show that both ACP and ARCP yield similar outcomes on cardiac systolic, diastolic, conduction system, and left ventricular functions. Revascularization has positive effects on systolic, diastolic, left ventricular, and conduction system function, leading to a significant improvement in segmental systolic and diastolic functions of the heart in the first month postoperatively.