Short-term clinical outcomes for intermittent cold versus intermittent warm blood cardioplegia in 2200 adult cardiac surgery patients
| Autor: | Bruno K. Podesser, Andreas Gleiss, Michaela Boxleitner, Christoph Holzinger, Hermann Kassal, Karola Trescher, Wolfgang Dietl |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Time Factors 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences Coronary artery bypass surgery 0302 clinical medicine Postoperative Complications Hypothermia Induced Risk Factors Internal medicine medicine Odds Ratio Humans Cardiac Surgical Procedures Coronary Artery Bypass Stroke Aged Retrospective Studies Univariate analysis Ejection fraction Chi-Square Distribution Troponin T business.industry Atrial fibrillation General Medicine Odds ratio Middle Aged medicine.disease Heart Valves Cardiac surgery Logistic Models Treatment Outcome 030228 respiratory system Anesthesia Cardiology Heart Arrest Induced Surgery Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of cardiovascular surgery. 58(1) |
| ISSN: | 1827-191X |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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