Surgical results of only antegrade del Nido cardioplegia infusion in conventional coronary artery bypass grafting: a retrospective study

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.