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DOI: 10.1055/s-0030-1269021
Comparison of warm versus cold blood cardioplegia for myocardial protection in patients with prolonged aortic cross-clamp times during isolated CABG and aortic valve surgery
Objectives: To compare the cardioprotective effects of intermittent warm (IWC) versus intermittent cold blood cardioplegia (ICC) in cardiac surgery patients undergoing isolated cardiac coronary artery bypass grafting (CABG) or aortic valve replacement procedures (AVR) that require prolonged periods of aortic clamping.
Methods: From 3527 consecutive cardiac surgery patients, 458 patients were retrospectively identified that underwent isolated CABG (n=314; IWC n=248 vs. ICC n=66) and isolated AVR (n=144; IWC n=67 vs. ICC n=77) requiring aortic cross-clamp times >60 minutes. Groups were compared with regard to the release of markers for myocardial injury (CK-MB, cTnT) and clinical outcomes including 30-day mortality, perioperative myocardial infarction (PMI) and major adverse cardiac events (MACE).
Results: Demographic data, logistic Euroscore, aortic-cross-clamping and CPB time were comparable between the CABG and AVR groups. ICC-patients needed more defibrillations after aortic unclamping in both CABG and AVR (p<0.05). Postoperative elevation of CK-MB and cTnT was significantly higher in the IWC-treated patients undergoing CABG compared to the ICC group (p<0.05). Warm blood cardioplegia was associated with higher PMI in CABG patients (p=0.06), while no differences where found among AVR groups. In CABG patients, the use of ICC was linked to higher need for blood transfusions (p=0.03). Nonetheless, the cardioplegic strategy during isolated CABG or AVR had no influence on the incidence of 30-day mortality or MACE.
Conclusions: ICC offers improved myocardial protection in patients undergoing isolated cardiac procedures with prolonged aortic cross-clamp periods compared to IWC that, however, fails to translate into better clinical outcomes.