Thorac Cardiovasc Surg 2010; 58 - MP64
DOI: 10.1055/s-0029-1246885

Myocardial protection in cardiac surgery patients requiring prolonged aortic cross-clamp times: a single-center evaluation of clinical outcomes comparing two blood cardioplegic strategies

E Kuhn 1, O Liakopoulos 1, YH Choi 1, T Wittwer 1, N Madershahian 1, G Wassmer 2, T Wahlers 1
  • 1Universität zu Köln, Herz- & Thoraxchirurgie, Köln, Germany
  • 2Universität zu Köln, Medizinische Statistik, Informatik und Epidemiologie, Köln, Germany

Aim: To evaluate the impact of intermittent warm (IWC) versus intermittent cold blood cardioplegia (ICC) in high-risk patients that require prolonged periods of aortic cross-clamping during on-pump cardiac surgery.

Methods: From 3527 consecutive patients undergoing on-pump cardiac surgery, 520 patients were retrospectively identified that required prolonged aortic cross-clamping >75min. Myocardial protection was performed with ICC (n=280) or IWC (n=240). Groups were compared regarding clinical outcomes, myocardial injury (CK-MB, cTnT) and multivariate analysis was performed to assess the impact of applied cardioplegia on 30-day-all-cause mortality, cardiac death, perioperative myocardial injury (PM) and major adverse cardiac events (MACE).

Results: Demographic data, mean logistic Euroscore, aortic-cross-clamping and CPB time were comparable between groups. Patients with ICC needed more intraoperative defibrillations, had more postoperative blood transfusions and a prolonged hospital stay when compared to the IWC-group (p< .05). 30-day-all-cause mortality tended to be higher in IWC (11% vs. 6%; p=.083) with significantly higher cardiac mortality (9% vs. 4%; p=.015) compared to ICC. Myocardial injury was more pronounced in the IWC-group with a higher incidence of PMI (IWC: 17% vs. ICC: 6%; p< .05) and MACE (IWC: 37% vs. ICC: 25%; p< .05). Groups did not differ regarding other postoperative clinical outcomes. Multivariate analysis revealed IWC to be independently predictive (p< .05) for 30-day-all-cause mortality (OR: 2.42; 95% CI: 1.04–5.05), cardiac death (OR: 3.57; 95% CI: 1.49–8.85), MACE (OR: 1.87; 95% CI: 1.22–2.87) and PMI (OR: 3.46; 95% CI: 1.86–6.41).

Conclusion: ICC results in less myocardial damage and reduced postoperative cardiac mortality and morbidity in patients requiring extended periods of aortic-cross-clamping during on-pump cardiac surgery, suggesting superior cardioprotection when compared to IWC.