Antegrade-Retrograde Cold Blood Cardioplegia versus Antegrade Cardioplegia on Myocardial Function after Tetralogy of Fallot Repair

Background-Antegrade and retrograde infusion of cardioplegia may provide more homogenous distribution of cardioplegia, especially in cases of coronary artery disease, but it has not been tested in tetralogy of Fallot repair. The purpose of this study was to compare antegrade and intermittent antegrade-retrograde cardioplegia on myocardial function following total correction of tetralogy of Fallot. Methods-Fifty-two patients were non-randomly studied in two groups for a comparison between operational results after using the two said methods. In the antegrade-retrograde method (group A), 15-20 ml/kg cold blood cardioplegia was infused antegrade, followed by 8-10 ml/kg of retrograde infusion. Antegrade-retrograde route of infusion was repeated every 20 minutes (10 ml/kg and 8 ml/kg, respectively). In the antegrade group (group B), 15-20 ml/kg of cold blood cardioplegia was infused, followed by 10 ml/kg in repeated doses every 20 minutes. Important variables of myocardial performance were compared in the two groups. Results-The two groups had similar preoperative characteristics (age, sex, body mass index). The mortality was 1 (3.8%) in group A and 5 (19%) in group B (P<0.05). Postoperative infusion of epinephrine and the dosage used were higher in group B (P<0.022), but the duration of its use was not different. Need for dobutamine, its dosage and duration of use were different in group B (P<0.002, P<0.007 and P<0.001, respectively). Dopamine infusion, dosage and duration were significantly different in the two groups (P<0.011, P<0.034 and P<0.011, respectively). Significant differences for ventilatory support were seen in the two groups (P<0.043), but ICU stay in the two groups was not significantly different. Conclusion-In light of our findings, it is concluded that there is a significantly better postoperative myocardial performance and lower mortality following antegrade-retrograde cardioplegia. We consequently recommend it as a routine method for myocardial protection in non-infantile repair of tetralogy of Fallot.