Buckberg versus Calafiore Cardioplegia in Patients with Acute Coronary Syndromes
Elmar W Kuhn1, Oliver Liakopoulos1, Ingo Slottosch1
1Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany.
Insights
Intermittent warm (Calafiore) and cold blood (Buckberg) cardioplegia provide similar myocardial protection and outcomes for patients undergoing coronary artery bypass graft surgery due to acute coronary syndromes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardioplegia
Background:
- Cardioplegia solution choice is critical in specific cardiac surgery patient subgroups.
- This study compares intermittent warm (Calafiore) versus cold blood (Buckberg) cardioplegia for acute coronary syndromes (ACS) patients undergoing coronary artery bypass graft (CABG) surgery.
Purpose of the Study:
- To assess the impact of intermittent warm (Calafiore) versus intermittent cold blood (Buckberg) cardioplegia.
- To compare clinical outcomes and perioperative myocardial injury (PMI) in ACS patients undergoing CABG.
Main Methods:
- Retrospective analysis of 950 urgent on-pump CABG patients (2008-2015) due to ACS.
- Intraoperative cardiac arrest induced with Buckberg (n=273) or Calafiore (n=677) cardioplegia.
- Propensity score matching performed to control for preoperative differences.
Main Results:
- Preoperative differences existed, with more complex cases in both groups.
- Unmatched analysis showed comparable 30-day mortality, MACE, and PMI between Buckberg and Calafiore groups.
- Propensity score matching (n=212 each) revealed no significant differences in 30-day mortality, MACE, or PMI, though more Buckberg patients required prolonged inotropic support.
Conclusions:
- Buckberg and Calafiore cardioplegia demonstrate comparable myocardial protection.
- Both cardioplegia strategies yield similar postoperative results in ACS patients undergoing CABG surgery.
Background:
Choice of cardioplegic solution plays a pivotal role in special subgroups of patients referred for on-pump cardiac surgery. This retrospective analysis aimed to assess the impact of intermittent warm (Calafiore, Cala) versus intermittent cold blood cardioplegia (Buckberg, Buck) in patients referred to coronary artery bypass graft (CABG) surgery due to acute coronary syndromes (ACS).
Methods:
From 2008 to 2015, all consecutive patients undergoing urgent on-pump CABG surgery due to ACS (n = 950) were retrospectively analyzed. Intraoperative cardiac arrest was achieved using Buck (n = 273) or Cala (n = 677). Patients were compared regarding clinical outcomes and perioperative myocardial injury (PMI). Propensity score matching was performed to control for differences in preoperative patient characteristics.
Results:
Prevalences of left main stenosis >50%, COPD, and advanced New York Heart Association (NYHA) class were higher for intermittent warm blood cardioplegia (IWC)-patients while more Buck-patients had preoperative intra-aortic balloon pump (IABP) and redo procedures. Buck-patients needed more intraoperative defibrillations and showed longer cardiopulmonary bypass (CPB) and aortic clamping times. 30-day all-cause mortality (10.6 versus 9.3%), major adverse cardiac events (MACE) (52.7 versus 48.6%), and PMI (50.5 versus 55.7%; all p > 0.05) rates were comparable for Buck- and Cala-patients. Propensity score matching resulted in equal group sizes (n = 212 each) and balanced distribution of preoperative covariates. Although more Buck-patients still needed inotropic support >24 hours postoperatively (25.7 versus 14.7%; p = 0.005) compared with Cala-group, outcome variables of interest did not differ between treatment groups (30-day mortality: 7.5 versus 9.0%; MACE: 49.5 versus 40.6%; PMI: 48.1 versus 37.3%; all p > 0.05).
Conclusion:
Buckberg and Calafiore cardioplegia offer comparable myocardial protection and similar postoperative results in patients undergoing CABG surgery due to ACS.
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