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The Journal of Cardiovascular Surgery 2010 December;51(6):895-905

Copyright © 2010 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

Liakopoulos O. J., Kuhn E. W., Choi Y. H., Chang W., Wittwer T., Madershahian N., Wassmer G., Wahlers T.

1 Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany; 2 Department for Medical Statistics, Informatics, and Epidemiology, University of Cologne, Cologne, Germany


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AIM: The aim of this study was 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 3 527 consecutive patients undergoing on-pump cardiac surgery, 520 patients were retrospectively identified that required prolonged aortic cross-clamp ≥75 min. 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<0.05). Thirty-day all-cause mortality tended to be higher in IWC (11% vs. 6%; P=0.083) with significantly higher cardiac mortality (9% vs. 4%; P=0.015) compared to ICC. Myocardial injury was more pronounced in the IWC-group with a higher incidence of PMI (IWC: 17% vs. ICC:6%; P<0.05) and MACE (IWC:37% vs. ICC:25%; P<0.05). Groups did not differ regarding other postoperative clinical outcomes. Multivariate analysis revealed IWC to be independently predictive (P<0.05) 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.

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