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Published on: March 27, 2018
Microplegia versus Cardioplexol® in Coronary Artery Bypass Surgery with Minimal Extracorporeal Circulation:
Luca Koechlin1, Bejtush Rrahmani1, Brigitta Gahl1
1Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
Background:
The aim of this study is to compare the combined use of the Myocardial Protection System and our microplegia (Basel Microplegia Protocol) with Cardioplexol® in coronary artery bypass grafting using the minimal extracorporeal circulation.
Methods:
The analysis focused on propensity score matched pairs of patients in whom microplegia or Cardioplexol® was used. Primary efficacy endpoints were high-sensitivity cardiac troponin-T on postoperative day 1 and peak values during hospitalization. Furthermore, we assessed creatine kinase and creatinine kinase-myocardial type, as well as safety endpoints.
Results:
A total of 56 patients who received microplegia and 155 patients who received Cardioplexol® were included. The use of the microplegia was associated with significantly lower geometric mean (confidence interval) peak values of high-sensitivity cardiac troponin-T (233 ng/L [194-280 ng/L] vs. 362 ng/L [315-416 ng/L]; p = 0.001), creatinine kinase (539 U/L [458-633 U/L] vs. 719 U/L [645-801 U/L]; p = 0.011), and creatinine kinase-myocardial type (13.8 µg/L [9.6-19.9 µg/L] vs. 21.6 µg/L [18.9-24.6 µg/L]; p = 0.026), and a shorter length of stay on the intensive care unit (1.5 days [1.2-1.8 days] vs. 1.9 days [1.7-2.1 days]; p = 0.011). Major adverse cardiac and cerebrovascular events occurred with roughly equal frequency (1.8 vs. 5.2%; p = 0.331).
Conclusions:
The use of the Basel Microplegia Protocol was associated with lower peak values of high-sensitivity cardiac troponin-T, creatinine kinase, and creatinine kinase-myocardial type and with a shorter length of stay on the intensive care unit, as compared with the use of Cardioplexol® in isolated coronary artery bypass surgery using minimal extracorporeal circulation.
Insights
The Basel Microplegia Protocol, combined with minimal extracorporeal circulation, demonstrated superior myocardial protection during coronary artery bypass grafting compared to Cardioplexol®. This resulted in lower cardiac enzyme levels and reduced intensive care unit stays.
Area of Science:
- Cardiovascular Surgery
- Cardioprotection
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) often utilizes cardiopulmonary bypass with cardioplegia for myocardial protection.
- Minimal extracorporeal circulation (MECC) aims to reduce the systemic inflammatory response and complications associated with traditional cardiopulmonary bypass.
- Assessing novel cardioplegia solutions within MECC is crucial for optimizing surgical outcomes.
Purpose of the Study:
- To compare the efficacy and safety of the Basel Microplegia Protocol (BMP) combined with MECC against Cardioplexol® in CABG procedures.
- To evaluate myocardial injury markers and clinical outcomes in patients undergoing CABG with these two cardioplegia strategies.
Main Methods:
- A propensity score-matched analysis was conducted on patients undergoing CABG using MECC.
- Patients received either the BMP or Cardioplexol® for myocardial protection.
- Primary efficacy endpoints included high-sensitivity cardiac troponin-T (hs-cTnT) and peak creatine kinase-myocardial type (CK-MB) levels.
- Secondary endpoints included safety events and length of intensive care unit (ICU) stay.
Main Results:
- The BMP group (n=56) showed significantly lower peak hs-cTnT (233 vs. 362 ng/L, p=0.001) and CK-MB (13.8 vs. 21.6 µg/L, p=0.026) compared to the Cardioplexol® group (n=155).
- Creatine kinase levels were also significantly lower in the BMP group (539 vs. 719 U/L, p=0.011).
- Patients receiving BMP had a shorter ICU length of stay (1.5 vs. 1.9 days, p=0.011).
- Major adverse cardiac and cerebrovascular events occurred with similar frequency (1.8% vs. 5.2%, p=0.331).
Conclusions:
- The Basel Microplegia Protocol, when used with minimal extracorporeal circulation in CABG, offers superior myocardial protection compared to Cardioplexol®.
- This improved protection is evidenced by reduced cardiac biomarker release and a shorter ICU stay.
- BMP represents a potentially advantageous cardioplegia strategy for CABG patients undergoing MECC.
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