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DOI: 10.1055/s-0031-1297416
Intermittent cold blood cardioplegia compared to intermittent warm blood cardioplegia and Bretschneider cardioplegia in elective aortic valve replacement
Introduction: Several studies have been performed comparing intermittent cold blood (ICBC) and warm blood cardioplegia (IWBC). However, there is no study comparing those to cold crystalloid cardioplegia (CC). The aim of this retrospective study was to compare the three above mentioned techniques in aortic valve replacement (AVR) surgery.
Methods: A retrospective analysis of all elective AVR was performed comparing ICBC (n=144), IWBC (n=128), and CC (n=142) cardioplegia from 2002 to 2010. Endpoints used were: Euroscore, aortic cross clamp time, perioperative transfused blood, length of ICU stay, postoperative arrhythmias, postoperative ischemia biomarkers and duration of operation.
Results: Demographic data was comparable between all three groups.
|
IWBC |
p-value |
ICBC |
p-value |
CC |
p-value IWBC vs. CC |
|
|
Euroscore |
4.37±2.04 |
0.311 |
4.35±1.99 |
0.0114 |
3.96±1.35 |
0.096 |
|
Aortic cross clamp time (min) |
57.55±16.2 |
0.180 |
60.63±20.9 |
0.230 |
63.97±25.9 |
0.017 |
|
Perioperative bloodtransfusions |
357.74±496.04 |
0.095 |
459.02±494.96 |
<0.001 |
239.29±361.48 |
0.025 |
|
Ventilation (hrs) |
14.5±5.4 |
0.066 |
16.38±9.9 |
0.054 |
19.2±13.1 |
<0.001 |
|
Application of catecholamines (hrs) |
16.32±16.56 |
0.257 |
19.07±18.07 |
<0.001 |
33.0±21.73 |
<0.001 |
|
Drainage quantity (ml) |
519.61±472.82 |
0.044 |
729.18±998.17 |
0.485 |
824.9±826.4 |
0.002 |
|
CK-MB (6h postoperative) (U/l) |
29.85±15.9 |
0.418 |
31.78±21.1 |
0.027 |
42.78±54.57 |
0.014 |
|
CK (6h postoperative) (U/l) |
588.26±744.1 |
0.124 |
479.25±357.25 |
0.494 |
518.82±583.32 |
0.397 |
|
Trop-T (6h postoperative) (ug/l) |
1.05±2.39 |
0.264 |
0.73±1.12 |
0.910 |
0.78±0.89 |
0.767 |
[Perioperative data]
Conclusion: ICBC, IWBC and CC are comparable cardioplegic strategies for patients undergoing elective AVR surgery. However CC cardioplegia led to disadvantages regarding postoperative myocardial injury, time of ventilation, application time of catecholamines and drainage quantity. However, this disadvantage did not reach clinical relevance.