{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:09:47Z","timestamp":1792789787972,"version":"4.5.0"},"reference-count":29,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Institut za kardiovaskularne bolesti Dedinje","id":[{"id":"https:\/\/ror.org\/01k57xn28","id-type":"ROR","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/01k57xn28","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Myocardial protection during on-pump coronary artery bypass grafting (CABG) limits ischaemic injury, particularly in patients with left main coronary artery disease (LMCAD), in whom severe proximal stenosis may compromise antegrade cardioplegia delivery. We investigated whether combined antegrade\u2013retrograde blood cardioplegia reduces postoperative high-sensitivity cardiac troponin I (hs-cTnI) concentrations, a marker of perioperative myocardial injury. Materials and Methods: We conducted a prospective, single-centre, randomised trial involving 60 adults undergoing elective isolated on-pump CABG for significant LMCAD. Patients were assigned (1:1) to antegrade-only or combined antegrade\u2013retrograde blood cardioplegia. Cardiac biomarkers were measured after induction and at 4, 12, 24, and 48 h after ICU admission. The primary endpoint was peak hs-cTnI within 48 h; key secondary endpoints included the hs-cTnI area under the concentration\u2013time curve, CK-MB, immediate myocardial electrical recovery and 30-day outcomes. Results: All patients received the assigned cardioplegia strategy, with no crossover. Peak hs-cTnI did not differ significantly between the antegrade-only and combined groups (median 529.1 [IQR 829.9] vs. 394.1 [503.4] ng\/L; p = 0.21), nor did the hs-cTnI area under the concentration\u2013time curve from 4 to 48 h (12,910.6 [23,127.4] vs. 8112.2 [11,686.2] ng\u00b7h\/L; p = 0.16). Serial hs-cTnI, CK-MB, total creatine kinase, serum creatinine, immediate myocardial electrical recovery, and 30-day outcomes also did not differ significantly. No deaths, coronary sinus injuries, or other cardioplegia-related complications occurred. Conclusions: In patients undergoing isolated on-pump CABG for significant LMCAD, combined antegrade\u2013retrograde blood cardioplegia did not significantly decrease peak hs-cTnI levels compared to the antegrade-only method. The combined approach was feasible with no cardioplegia-related complications, suggesting that an individualised strategy may be preferable to a routine one. Larger prospective studies are needed to determine whether higher-risk patients may derive greater benefit.<\/jats:p>","DOI":"10.3390\/medicina62091799","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:25:43Z","timestamp":1789986343000},"page":"1799","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined Antegrade\u2013Retrograde Cardioplegia for Myocardial Protection During Coronary Artery Bypass Grafting in Patients with Left Main Coronary Artery Disease: The CARDIOPROTECT-LMCAD Randomised Trial"],"prefix":"10.3390","volume":"62","author":[{"given":"Jelena","family":"Lesanovic","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Institute for Cardiovascular Diseases Dedinje, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0984-9011","authenticated-orcid":false,"given":"Milan","family":"Milojevic","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Institute for Cardiovascular Diseases Dedinje, Milana Tepica 1, 11000 Belgrade, Serbia"},{"name":"Department of Cardiovascular Research, Institute for Cardiovascular Diseases Dedinje, 11000 Belgrade, Serbia"},{"name":"Department of Cardiac Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Djordje","family":"Nikolic","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Institute for Cardiovascular Diseases Dedinje, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Soldatovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7066-6292","authenticated-orcid":false,"given":"Dragana","family":"Unic-Stojanovic","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Institute for Cardiovascular Diseases Dedinje, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Zivkovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Cardiac Surgery, Institute for Cardiovascular Diseases Dedinje, Milana Tepica 1, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2468-1926","authenticated-orcid":false,"given":"Miroslav","family":"Milicic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Cardiac Surgery, Institute for Cardiovascular Diseases Dedinje, Milana Tepica 1, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9009-069X","authenticated-orcid":false,"given":"Petar","family":"Vukovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Cardiac Surgery, Institute for Cardiovascular Diseases Dedinje, Milana Tepica 1, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Petrovic","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinisa","family":"Jagodic","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Institute for Cardiovascular Diseases Dedinje, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6969-0195","authenticated-orcid":false,"given":"Milovan","family":"Bojic","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Slobodan","family":"Micovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Cardiac Surgery, Institute for Cardiovascular Diseases Dedinje, Milana Tepica 1, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur. 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