Propensity Matched Analysis of del Nido Cardioplegia in Adult Coronary Artery Bypass Grafting: Initial Experience With 100 Consecutive Patients

Autor: Daniel Nadeau, Jeff Clousing, Charles L. Willekes, Ben Himelhoch, Andrew Borgman, Tomasz A. Timek, Dick Kanten, Joe Wagner, Olivia L. Hulme
Rok vydání: 2016
Předmět:
Adult
Male
Reoperation
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Operative Time
Myocardial Ischemia
Coronary Artery Disease
030204 cardiovascular system & hematology
Risk Assessment
law.invention
Cohort Studies
Coronary artery disease
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
law
Internal medicine
Cardiopulmonary bypass
Humans
Medicine
Hospital Mortality
Coronary Artery Bypass
Propensity Score
Cardioplegic Solutions
Survival rate
Retrospective Studies
Troponin T
business.industry
Middle Aged
medicine.disease
Cardiac surgery
Survival Rate
Treatment Outcome
medicine.anatomical_structure
030228 respiratory system
Anesthesia
Propensity score matching
Heart Arrest
Induced
Cardiology
Milrinone
Female
Surgery
Patient Safety
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Artery
medicine.drug
Zdroj: The Annals of Thoracic Surgery. 101:2237-2241
ISSN: 0003-4975
DOI: 10.1016/j.athoracsur.2015.12.058
Popis: Del Nido cardioplegia (DC) offers prolonged cardiac protection with single-dose administration and has had a long safety record in pediatric cardiac surgery. However, its application in the adult population has thus far been limited. We evaluated the efficacy of cardiac protection and clinical outcomes of DC vs blood cardioplegia (BC) in adult coronary artery bypass graft (CABG) patients.Clinical outcomes of 100 consecutive isolated CABG patients who received DC (May to September 2014) were compared with the previous 100 consecutive isolated CABG patients receiving BC (December 2013 to April 2014). Propensity matching yielded 82 pairs. The same surgeons operated on all patients. Clinical patient characteristics and data were extracted from our local The Society of Thoracic Surgeons database and the electronic medical record.Preoperative characteristics were similar between BC and DC patients before and after propensity matching. BC patients received anterograde and retrograde cardioplegia, whereas DC was delivered anterograde, with 92 of 100 patients receiving a single dose only. Inotropic support upon arrival to the recovery unit did not differ between BC and DC (0.28 ± 0.11 vs 0.27 ± 0.11 μg/kg/min milrinone [p = 0.8] and 0.05 ± 0.03 vs 0.05 ± 0.03 μg/kg/min norepinephrine [p = 0.7]), nor did postoperative troponin T levels (0.56 ± 0.48 vs 0.70 ± 1.27 ng/mL; p = 0.3). The peak intraoperative glucose level was higher in BC (209.8 ± 40.4 mg/dL) than in DC (161.4 ± 42.3 mg/dL) patients (p0.001). No patients died in either group, and the postoperative incidence of atrial fibrillation, stroke, reoperation for bleeding, and prolonged intubation did not differ between the groups before and after matching. There was also no difference in the postoperative ejection fraction between the groups (0.51 ± 0.13 vs 0.47 ± 0.13 for BC and DC, respectively; p = 0.17).In our initial experience, DC provided equivalent myocardial protection and clinical outcomes to BC in adult isolated CABG patients. DC was associated with lower cardiopulmonary bypass glucose levels than BC and demonstrated the feasibility of single-dose administration for routine coronary operations.
Databáze: OpenAIRE
Externí odkaz: