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Celsior Versus Microplegia: Analysis of Myocardial Protection in Elective Aortic Valve Replacement
Jose López-Menéndez1, Javier Miguelena1, Carlos Morales2
1Cardiac Surgery, Ramón y Cajal Hospital, Madrid, Spain.
Insights
Celsior crystalloid solution demonstrated improved myocardial protection and reduced postoperative death compared to microplegia in aortic valve replacement. This study highlights Celsior as a safe and effective cardioplegic solution.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardioplegia
Background:
- Efficacy of crystalloid cardioplegic solutions is established.
- Celsior's use as a cardioplegic solution remains unevaluated.
Purpose of the Study:
- To compare Celsior crystalloid solution with all-blood continuous myocardial protection (microplegia).
- To evaluate myocardial protection surrogates, 30-day mortality, and Celsior safety in aortic valve replacement.
Main Methods:
- Observational retrospective study of 631 patients undergoing elective aortic valve replacement.
- Comparison of Celsior versus microplegia for myocardial protection.
- Primary endpoints: myocardial protection surrogates and 30-day death. Secondary endpoint: Celsior safety.
Main Results:
- Celsior group showed lower adjusted postoperative death (OR 0.33).
- Troponin T release, a predictor of death, increased less with clamp time in the Celsior group.
- No significant differences in inotropic support or intraaortic balloon pump use; Celsior was safe with no unexpected toxicity.
Conclusions:
- Isolated crystalloid Celsior is a safe and potentially optimal myocardial protection strategy.
- Celsior demonstrates favorable outcomes in aortic valve replacement surgeries.
Background:
Previous studies have analyzed the efficacy of crystalloid cardioplegic solutions, but the use of Celsior (Genzyme Corp, Boston, MA) as a crystalloid cardioplegic solution has not been evaluated.
Methods:
In this observational retrospective study, Celsior crystalloid solution was compared with an all-blood continuous myocardial protection (microplegia). The study included all patients who underwent elective aortic valve replacement operations in whom the myocardial protection was Celsior or microplegia. The primary end points were surrogates of myocardial protection and death at 30 days. The secondary end point was the safety analysis of the use of Celsior.
Results:
The study included 631 patients, divided in two groups: 219 (34.7%) with microplegia and 412 (65.3%) with Celsior. Troponin T release accurately predicted postoperative death (area under the receiver operating characteristic curve = 0.85). Troponin T increased with the duration of clamp time, and the adjusted time-related increase was lower in the Celsior group. There were no statistically significant differences in the postoperative use of inotropic medication or intraaortic balloon pump. Adjusted postoperative death was lower in Celsior group (odds ratio, 0.33; 95% confidence interval, 0.15 to 0.76). There were no allergic reactions attributed to Celsior and no unexpected toxicity with the use of Celsior (coagulopathy, renal dysfunction, liver dysfunction, or encephalopathy).
Conclusions:
Isolated crystalloid Celsior may be an optimal and safe myocardial protection strategy in aortic valve replacement operations.
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