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Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
Online ISSN 1827-191X
Trescher K. 1, Gleiss A. 2, Boxleitner M. 1, Dietl W. 1, Kassal H. 1, Holzinger C. 1, Podesser B. K. 1
1 Department of Cardiac Surgery, University Hospital St. Pölten, St. Pölten, Austria;
2 Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
AIM: Aim of the present study was to compare clinical outcome of intermittent cold (ICC) versus intermittent warm (IWC) blood cardioplegia in different cardiosurgical procedures.
METHODS: 2188 patients were retrospectively divided into 5 groups: isolated coronary artery bypass surgery (CABG,n=1203), isolated aortic valve surgery (AVR,n=374), isolated mitral valve surgery (MVR,n=151), combined AVR+CABG (n=390), and combined MVR+CABG (n=70). Myocardial protection was performed by ICC (n=1578) or IWC (n=610) blood cardioplegia. In logistic regression models the effect of cardioplegia on 30-day mortality, IABP/ECLS (intraaortic balloon-pump/extracorporal life support) implantation, transient neurological deficit, stroke, renal failure, new-onset atrial fibrillation, and troponin T release was estimated. Potential modifications of the effect of cardioplegia by logistic EuroSCORE, crossclamp-time, ejection fraction, and op-status elective versus urgent/emergent were investigated.
RESULTS: There were no statistically significant differences between ICC and IWC regarding 30-day mortality (OR:0.70;95%CI:0.39-1.23;P=0.219), IABP/ECLS support (OR:0.60;95%CI:0.23-1.55;P=0.294), transient neurological deficit (OR:0.90;95%CI:0.65-1.24;P=0.541), stroke (OR:0.79;95%CI:0.401.54;P=0.495), renal failure (OR:1.07;95%CI:0.57-1.99;P=0.825), and atrial fibrillation (OR:0.96;95%CI:0.77-1.18;P=0.713) across all 5 groups. Troponin t release was significantly higher in ICC compared to IWC (by 0.029 ± 0.015ng/mL;P=0.046) in univariate analysis; this effect was lowered by risk-factor adjustment and lost statistical significance. The effect of cardioplegia was not significantly different between groups. In urgent/emergent surgery ICC resulted in a significantly higher 30-day mortality (OR:3.03;P=0.024) compared to IWC.
CONCLUSION: The comparison of IWC and ICC blood cardioplegia in different cardiosurgical procedures showed no statistical significant difference in myocardial protection. The use of ICC, however, appeared overall associated with a slightly better clinical outcome except in patients undergoing urgent/emergent CABG where IWC led to a reduction in 30-day-mortality.