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DOI: 10.1055/s-0034-1367296
The impact of using warm vs. cold blood cardioplegia in patients underwent emergent CABG procedure
Objective: Aim of this study was to determine whether intermittent warm (IWC) or cold bloodcardioplegia (ICC) show superior myocardial protection in emergent CABG-patients with less than 60 minutes aortic cross-clamp time (Ao-X).
Methods: Out of 1,945 consecutive patients who underwent isolated CABG-surgery 247 consecutive emergent patients were identified and control-matched with 452 elective patients (1:2 ratio-match for emergent versus elective, regarding gender, age ( < 50 years, 50-70 years, >70 years) and ejection fraction ( < 40%, 40-50%, >50%).
Results: Demographics, CPB-time, log. Euroscore, number of distal anastomosis and LITA-use were comparable. The Ao-X was significantly prolonged in the IWC-group regardless of the patients' status (emergent: ICC vs. IWC: 35.4 ± 12.2 min. vs. 41.1 ± 13.9 min.; p = 0.05, elective: ICC vs. IWC: 39.9 ± 12.7 min. vs. 44.0 ± 15.9 min.; p = 0.015). There were no significant differences regarding ICU-stay, ventilation time, total-blood-loss and need for dialysis. Multivariate analysis did not identify the type of cardioplegia as predictor for the 30-days mortality or for the incidence of a perioperative myocardial injury. However, the independent predictive factors for 30-days mortality were: EF < 40% (OR 3.66; 95%CI: 1.79-7.52; p < 0.001), AF (OR 3.33; 95%CI: 1.49-7.47; p < 0.003), PAD (OR 2.51; 95%CI: 1.13-5.55; p < 0.023) and COPD (OR 0.26; 95%CI: 1.05-6.21; p < 0.038) and for perioperative myocardial infarction: EF < 40% (OR 2.04; 95%CI: 1.32-3.15; p < 0.001), IABPpreop (OR 3.68; 95%CI: 1.34-10.13; p < 0.012), and hemofiltration (OR 3.61; 95%CI: 2.22-5.87; p < 0.001).
Conclusion: Although the Ao-X was prolonged in the IWC-group our results confirm effective cardioprotection under IWC in patients requiring Ao-X less than 60 minutes, independently of the urgency status of the patient.