الفهرس 
Acknowledgement
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Abstract
During coronary artery bypass surgery, ensuring myocardial protection, particularly of the right ventricle, may face challenges in cases of severe coronary lesions impeding the antegrade flow of cold cardioplegia. This asymmetrical cooling of the myocardium has been associated with subsequent right ventricular dysfunction, potentially exacerbating postoperative morbidity and mortality. Introduced in 1956 to facilitate aortic valve surgeries, retrograde coronary sinus perfusion later found application in myocardial protection during coronary artery bypass surgery in 1967.
Recently, there has been a resurgence of interest in this technique. A novel approach to delivering retrograde cardioplegia via the right atrium, pioneered by Fabiani et al., has mitigated concerns associated with direct coronary sinus cannulation, such as rupture, and has addressed worries about inadequate right ventricular perfusion. In contrast to antegrade delivery, retrograde delivery through the right atrium bypasses limitations imposed by occlusive coronary artery disease, thus allowing for more even cooling of the left ventricle.
The aim of this study is to compare simultaneous antegrade-retrograde cardioplegia with antegrade cardioplegia in complex coronary artery bypass surgeries
The study is a prospective, single-blinded randomized controlled trial at Assiut University Hospital’s Cardiothoracic Surgery Department. Inclusion criteria: age 18-60, LV ejection fraction 30-50%, left main stem CAD, mitral or aortic valve disease linked to ischemic heart disease. Exclusion criteria: double valve disease, congenital heart disease-associated valve issues, prior heart surgery, emergencies, poorly controlled diabetes. Enrolling ischemic heart disease patients with multi-vessel disease for CABG between Jan. 2020 and Jan. 2022.
The main results of our study were:
Demographic Data:
• Age: Mean age for Antegrade Group: 63.03 years (±3.16), for Ante-Retro Group: 63.33 years (±2.21), with no significant difference (p = 0.6678).
• Gender Distribution: Antegrade Group: 12 males (37.5%), 20 females (62.5%); Ante-Retro Group: 16 males (53.33%), 14 females (46.67%), not statistically significant (p = 0.2171).
• Weight: Ante-Retro group showed significantly lower weight compared to Antegrade Group: 87.59 kg (±5.89) vs. 83.63 kg (±5.82), respectively (p = 0.0118).
• BMI: Ante-Retro group had significantly lower BMI compared to Antegrade Group: 30.82 kg/m^2 (±3.4) vs. 28.25 kg/m^2 (±4.44), respectively (p = 0.022).
• Height: No significant difference observed between groups (p = 0.1018).
Echo (Preoperative) Data:
• LVESD: Mean for Antegrade Group: 3.2 (±0.23), for Ante-Retro Group: 3.16 (±0.16), not significant (p = 0.4845).
• LVEDD: Mean for Antegrade Group: 4.47 (±0.38), for Ante-Retro Group: 4.41 (±0.37), not significant (p = 0.3653).
• EF: Mean for Antegrade Group: 52.66% (±3.22), for Ante-Retro Group: 51.67% (±4.35), not significant (p = 0.172).