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The Journal of Cardiovascular Surgery 2018 February;59(1):115-20

DOI: 10.23736/S0021-9509.17.09979-7


lingua: Inglese

Is cold blood cardioplegia absolutely superior to cold crystalloid cardioplegia in aortic valve surgery?

Daniel A. LERMAN 1, 2 , Matilde OTERO-LOSADA 3, Kiddy UME 4, Pablo A. SALGADO 5, 6, 7, Sai PRASAD 1, Kelvin LIM 1, Bruno PÉAULT 2, 8, Nasri ALOTTI 9

1 Department of Cardiothoracic Surgery, Royal Infirmary Hospital of Edinburgh (NHS Lothian), University of Edinburgh, Edinburgh, UK; 2 MRC Center for Regenerative Medicine, University of Edinburgh, Edinburgh, UK; 3 Institute of Cardiological Investigation, University of Buenos Aires, National Research Council, Buenos Aires, Argentina; 4 Southern Illinois University School of Medicine, Springfield, IL, USA; 5 Faculty of Odontology, University of Buenos Aires, Buenos Aires, Argentina; 6 Center for Population Health Investigations, P. Durand Hospital, Buenos Aires, Argentina; 7 Ministry of Health of Argentina, Buenos Aires, Argentina; 8 University of California, Los Angeles, CA, USA; 9 Department of Cardiothoracic Surgery, Zala County St. Rafael Hospital, Pécs University, Pécs, Hungary

BACKGROUND: Experimental evidence suggests that blood cardioplegia (BCP) may be superior to cold crystalloid cardioplegia (CCP) for myocardial protection. However, robust clinical data are lacking. We compared postoperative outcome of patients undergoing aortic valve replacement (AVR) using cold anterograde-retrograde intermittent BCP versus anterograde (CCP).
METHODS: Adult consecutive isolated AVR performed between April 2006 and February 2011 at the Royal Infirmary Hospital of Edinburgh were retrospectively analyzed. The use of anterograde CCP was compared with that of intermittent anterograde-retrograde cold BCP. End points were intra-operative mortality, 30-day hospital re-admission, need for RBC or platelet transfusion, mechanical ventilation time and renal failure.
RESULTS: Of total 774 cases analyzed, 592 cases of BCP and 182 cases of CCP were identified. Demographics did not differ between groups (mean age: 67±12 years in CCP and 69±12 years in BCP). Groups (BCP vs. CCP) were indistinguishable (P>0.05, not significant) based on: average aortic cross clamp time 77.01±14.47 vs. 75.78±18.78 minutes, cardiopulmonary bypass time 104.07±43.70 vs. 100.34±25.90 minutes, surgery time 190.53±61.80 vs. 204.04±51.09 minutes and postoperative total blood consumption 1.38±2.11 vs. 1.61±2.4 units. The percentage of patients who required platelets’ transfusion was similar: 12.8% BCP and 18.7% CCP (Fisher’s exact test, P=0.053). Prevalence of respiratory failure was lower in BCP than in CCP: 2.6% vs. 6.3% (P=0.028). Admission time (days) at ICU was 3.63± 21.90 in BCP and 3.07±8.04 in CCP (not significant). Intra-hospital mortality, 30-day hospital re-admission, renal failure, sepsis, wound healing and stroke did not differ between groups.
CONCLUSIONS: BCP was strictly not superior to CCP in every aspect. In particular it was definitely not superior in terms of postoperative ventricular function. Our results question the absolute superiority of BCP over CCP in terms of hard outcomes. Likelihood of serious complications should be considered to improve risk profile of patients before choosing a cardioplegic solution.

KEY WORDS: Induced heart arrest - Aortic valve - Retrospective studies

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