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ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2017 February;58(1):105-12

DOI: 10.23736/S0021-9509.16.08525-X

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Short-term clinical outcomes for intermittent cold versus intermittent warm blood cardioplegia in 2200 adult cardiac surgery patients

Karola TRESCHER 1, Andreas GLEISS 2, Michaela BOXLEITNER 1, Wolfgang DIETL 1, Hermann KASSAL 1, Christoph HOLZINGER 1, Bruno K. PODESSER 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


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BACKGROUND: 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: Two thousand one hundred and eighty-eight 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, cross-clamping 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 (odds ratio [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: 0.40-1.54; 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±0.015 ng/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.
CONCLUSIONS: 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.


KEY WORDS: Cardiac surgery - Myocardial infarction - Cardioplegia

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