Background: From 1994 to 1996, 75 patients undergoing valve replacement were randomized to antegrade (36 patients, group 1) or antegrade/retrograde (39 patients, group 2) administration of cold blood cardioplegia.
Methods: Groups were comparable for age, sex, valve disease, and ventricular dysfunction. The aortic valve was replaced in 27 patients from group 1 and 24 patients from group 2, the mitral valve in 8 and 15 patients, and 1 patient in group 1 underwent double valve replacement (p = not significant).
Results: Lengths of cardiopulmonary bypass and aortic cross-clamp averaged, respectively, 10 minutes (p = not significant) and 12 minutes (p = < 0.05) shorter in group 2. Total amount of cardioplegia solution infused averaged 1,279 +/- 406 mL and 1,341 +/- 379 mL (p = not significant), respectively, in groups 1 and 2, and the period of infusion averaged 44% and 72% (p = < 0.01) of the total period of aortic cross-clamping. No death occurred in group 1 compared to two in group 2 (p = not significant). The perioperative myocardial infarction and stroke rates were comparable in both groups. Peak enzyme release at 24 hours was similar both for creatine kinase-MB fraction (26 versus 37 IU/L) and for troponin T (2.1 versus 2.5 IU/L).
Conclusions: Our study shows no significant advantage of the antegrade/retrograde administration of cardioplegia over the antegrade route in routine valvular replacement, other than a slightly shorter aortic cross-clamping time.