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Intermittent Cross-Clamp Fibrillation Versus Cardioplegic Arrest During Coronary Surgery in 6,680 Patients: A

Priyadharshanan Ariyaratnam1, Alexander Cale1, Mahmoud Loubani1

  • 1Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, United Kingdom.

Journal of Cardiothoracic and Vascular Anesthesia
|August 12, 2019
PubMed

Insights

Aortic cross-clamping followed by fibrillation (XCF) does not worsen in-hospital outcomes for coronary artery bypass grafting (CABG) surgery. However, cardioplegia offers a survival advantage, suggesting XCF may not be suitable for modern cardiac surgery.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia

Background:

  • Myocardial management during on-pump coronary artery bypass grafting (CABG) surgery involves distinct techniques.
  • Two primary methods include aortic cross-clamping followed by fibrillation (XCF) and aortic cross-clamping followed by diastolic cardioplegia (cardioplegia).

Purpose of the Study:

  • To compare in-hospital and long-term survival outcomes between XCF and cardioplegia in CABG patients.
  • To evaluate the efficacy and safety of different myocardial management strategies.

Main Methods:

  • Retrospective observational study utilizing propensity matching.
  • Analysis of 8,875 consecutive CABG patients, with 3,340 patients in each matched group (cardioplegia vs. XCF).
  • Comparison of pump times, cross-clamp times, postoperative arrhythmias, inotropic requirements, and long-term survival.

Main Results:

  • The XCF group exhibited significantly shorter pump and cross-clamp times.
  • Postoperative atrial arrhythmias and inotropic requirements were less frequent in the XCF group.
  • Despite similar in-hospital outcomes (excluding arrhythmias and inotropic support), the cardioplegia group demonstrated a statistically significant survival advantage (15.4 years vs. 14.7 years).

Conclusions:

  • XCF is not associated with adverse in-hospital outcomes in CABG surgery.
  • Cardioplegic arrest may confer a survival benefit compared to XCF.
  • The findings suggest that routine use of XCF may be precluded in contemporary cardiac surgery due to the long-term survival advantage associated with cardioplegia.
Abstract

Keywords:
CABGCardioplegiaCross Clamp Fibrillation

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