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The effect of using microplegia on perioperative morbidity and mortality in elderly patients undergoing cardiac
Turki B Albacker1, Rakesh Chaturvedi, Adil H Al Kindi
1Division of Cardiothoracic Surgery, Department of Surgery, McGill University Health Centre, McGill University, Montreal, Canada. dr_turki@yahoo.com
Abstract:
Old age is a significant risk factor for perioperative morbidity and mortality following cardiac surgery and optimal myocardial protection strategy should be sought in this group of patients. We, therefore, reviewed the data on 295 consecutive patients older than 75 years who underwent any cardiac surgical procedure. Microplegia was used in 144 patients compared to 151 patients who had the standard 4:1 blood cardioplegia. Logistic regression analysis was used for propensity matching to balance the differences between the two groups. The microplegia group included more females and sicker patients as indicated by higher Parsonnet scores. There were differences in the pump time, aortic cross-clamp time, procedure type and surgeons between the two groups. These differences were balanced using the propensity matching. In-hospital mortality, acute renal injury and confusion were higher in the microplegia group (17%, 34%, 35%, respectively) compared to the standard 4:1 cardioplegia group (9%, 23%, 24%, respectively) (P=0.04, 0.04, 0.04, respectively). These differences were not statistically significant after propensity matching. These results demonstrate that the use of microplegia is safe in patients older than 75 years who are undergoing cardiac surgery and results in similar in-hospital morbidity and mortality to the standard 4:1 blood cardioplegia.
Insights
Microplegia is a safe myocardial protection strategy for patients over 75 undergoing cardiac surgery. This method showed similar in-hospital morbidity and mortality rates compared to standard blood cardioplegia after propensity matching.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Advanced age increases risks for perioperative complications in cardiac surgery.
- Optimal myocardial protection is crucial for elderly patients undergoing cardiac procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of microplegia versus standard 4:1 blood cardioplegia in patients over 75 years old.
- To compare in-hospital morbidity and mortality between the two myocardial protection strategies in this elderly cohort.
Main Methods:
- Retrospective review of 295 patients aged over 75 undergoing cardiac surgery.
- Comparison between microplegia (n=144) and standard 4:1 blood cardioplegia (n=151).
- Propensity matching using logistic regression to balance baseline characteristics and surgical variables.
Main Results:
- Unmatched analysis showed higher in-hospital mortality, acute renal injury, and confusion in the microplegia group.
- After propensity matching, these differences were not statistically significant between the microplegia and standard cardioplegia groups.
- Propensity matching successfully balanced baseline differences, including Parsonnet scores, pump time, and aortic cross-clamp time.
Conclusions:
- Microplegia is a safe myocardial protection strategy for elderly patients (over 75) undergoing cardiac surgery.
- Microplegia yields comparable in-hospital morbidity and mortality outcomes to standard 4:1 blood cardioplegia in this population.
- These findings support the use of microplegia in older adults requiring cardiac surgical procedures.
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