TITLE:
Myocardial Protection during Cardiac Surgery: Warm Blood versus Crystalloid Cardioplegia
AUTHORS:
Helene De Bruyn, France Gelders, Tine Gregoir, Valerie Waelbers, Pascal Starinieri, Jean-Louis Pauwels, Jeroen Lehaen, Boris Robic, Alaaddin Yilmaz, Urbain Mees, Marc Hendrikx
KEYWORDS:
Myocardium, Protection, Ischemia/Reperfusion, Myocardial Infarction, Cardiac Surgery
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.4 No.9,
August
25,
2014
ABSTRACT:
Purpose: Prevention of myocardial injury is essential during cardiac
surgery. Both crystalloid and blood cardioplegia are popular methods for
myocardial protection. Most experimental studies have been in favor of blood
cardioplegia. The objective of this study is to determine whether the use of
warm blood cardioplegia (BCP) is superior to crystalloid cardioplegia (CCP) by
means of myocardial injury markers and clinical outcome parameters. Materials
and Methods: In a consecutive series of 293 patients, the first 150 received
crystalloid cardioplegia, whereas the next 143 patients received blood
cardioplegia. Postoperative myocardial injury was assessed by CTnI and CK-MB.
Perioperative morbidity and mortality and clinical outcome parameters (need for
inotropic support, ICU and hospital stay) were recorded. An unpaired student
t-test was performed to analyse continuous postoperative variables relating to
myocardial damage. The presence of possible confounders influencing the CTnI or
CK-MB concentrations was tested using a student t-test for continuous
variables, for categorical variables ANOVA was used. A final longitudinal model
was created for CTnI and CK-MB. CTnI was analyzed by a mixed model with random
intercept and slope. For all tests performed, statistical significance was 5%. Results:
Both groups were well matched with respect to preoperative variables. No
significant difference could be found in maximum postoperative levels of CTnI
(8.8 ± 18.4 μg/l in BCP vs 9.6 ± 16.5 μg/l in CCP, p = 0.6455) or CK-MB (19.2 ±
31.0 μg/l in BCP vs 26.4 ± 41.5 μg/l in CCP, p = 0.1209). Nor was there any
significant difference in other postoperative variables. Testing treatment
effect over time proved only significant influence of the surgical intervention
type on CTnI levels in time (p