Universität zu Köln

Zeriouh, Mohamed, Heider, Ammar, Rahmanian, Parwis B. ORCID: 0000-0002-3978-9251, Choi, Yeong-Hoon, Sabashnikov, Anton ORCID: 0000-0002-6289-1035, Scherner, Maximillian, Popov, Aron-Frederik ORCID: 0000-0003-4226-3004, Weymann, Alexander, Ghodsizad, Ali, Deppe, Antje-Christin, Kroener, Axel, Kuhn-Regnier, Ferdinand, Wippermann, Jens and Wahlers, Thorsten (2015). Six-years survival and predictors of mortality after CABG using cold vs. warm blood cardioplegia in elective and emergent settings. J. Cardiothorac. Surg., 10. LONDON: BIOMED CENTRAL LTD. ISSN 1749-8090

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Abstract

Background: The aim of this study was to determine whether intermittent warm blood cardioplegia (IWC) is associated with comparable myocardial protection compared to cold blood cardioplegia (ICC) in patients undergoing elective vs. emergent CABG procedures. Methods: Out of 2292 consecutive patients who underwent isolated on-pump CABG surgery using cardioplegic arrest either with ICC or IWC between January 2008 and December 2010, 247 consecutive emergent patients were identified and consecutively matched 1: 2 with elective patients based on gender, age (<50 years, 50-70 years, >70 years) and ejection fraction (<40 %, 40-50 %, >50 %). Perioperative outcomes and long-term mortality were compared between ICC and IWC strategies and predictors for 30-day mortality and perioperative myocardial injury were identified in both elective and emergent subgroups of patients. Results: Preoperative demographics and baseline characteristics, logistic Euroscore, CPB-time, number of distal anastomoses and LIMA-use were comparable. Aortic cross clamp time was significantly longer in the IWC-group regardless of the urgency of the procedure (p = 0.05 and p = 0.015 for emergent and elective settings). There were no significant differences regarding ICU-stay, ventilation time, total blood loss and need for dialysis. The overall 30-day, 1-, 3- and 6-year survival of the entire patient cohort was 93.7, 91.8, 90.4 and 89.1 %, respectively, with significantly better outcomes when operated electively (p < 0.001) but no differences between ICC and IWC both in elective (p = 0.857) and emergent (p = 0.741) subgroups. Multivariate analysis did not identify the type of cardioplegia as a predictor for 30-day mortality and for perioperative myocardial injury. However, independent factors predictive of 30-day mortality were: EF < 40 % (OR 3.66; 95 % CI: 1.79-7.52; p < 0.001), atrial fibrillation (OR 3.33; 95 % CI: 1.49-7.47; p < 0.003), peripheral artery disease (OR 2.51; 95 % CI: 1.13-5.55; p < 0.023) and COPD (OR 0.26; 95 % CI: 1.05-6.21; p < 0.038); predictors for perioperative myocardial infarction were EF < 40 % (OR 2.04; 95 % CI: 1.32-3.15; p < 0.001), preoperative IABP support (OR 3.68; 95 % CI: 1.34-10.13; p < 0.012), and hemofiltration (OR 3.61; 95 % CI: 2.22-5.87; p < 0.001). Conclusion: Although the aortic cross clamp time was prolonged in the IWC group our results confirm effective myocardial protection under IWC, regardless of the urgency of the procedure. We suggest that intermittent warm cardioplegia in emergent CABG setting is a low-cost alternative and safe. It is associated with similar long-term outcomes both in elective and emergent settings compared to intermittent cold cardioplegia.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Zeriouh, Mohamed UNSPECIFIED UNSPECIFIED UNSPECIFIED Heider, Ammar UNSPECIFIED UNSPECIFIED UNSPECIFIED Rahmanian, Parwis B. UNSPECIFIED orcid.org/0000-0002-3978-9251 UNSPECIFIED Choi, Yeong-Hoon UNSPECIFIED UNSPECIFIED UNSPECIFIED Sabashnikov, Anton UNSPECIFIED orcid.org/0000-0002-6289-1035 UNSPECIFIED Scherner, Maximillian UNSPECIFIED UNSPECIFIED UNSPECIFIED Popov, Aron-Frederik UNSPECIFIED orcid.org/0000-0003-4226-3004 UNSPECIFIED Weymann, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Ghodsizad, Ali UNSPECIFIED UNSPECIFIED UNSPECIFIED Deppe, Antje-Christin UNSPECIFIED UNSPECIFIED UNSPECIFIED Kroener, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhn-Regnier, Ferdinand UNSPECIFIED UNSPECIFIED UNSPECIFIED Wippermann, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-383916
DOI:	10.1186/s13019-015-0384-9
Journal or Publication Title:	J. Cardiothorac. Surg.
Volume:	10
Date:	2015
Publisher:	BIOMED CENTRAL LTD
Place of Publication:	LONDON
ISSN:	1749-8090
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INTERMITTENT ANTEGRADE WARM; IMPROVE MYOCARDIAL PROTECTION; MATCHED GENERAL-POPULATION; BYPASS GRAFT-SURGERY; CARDIAC-SURGERY; CRYSTALLOID CARDIOPLEGIA; EJECTION FRACTION; RANDOMIZED-TRIAL; STATIN THERAPY; 1ST OPERATION Multiple languages Cardiac & Cardiovascular Systems; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/38391