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Published on: September 15, 2023
Clinical outcomes of single-dose cardioplegia in high-risk coronary bypass
Serdar Gunaydin1, Orhan Eren Gunertem1, Seyhan Babaroglu1
1Department of Cardiovascular Surgery, City Hospital Campus, University of Health Sciences, Ankara, Turkey.
Insights
Del Nido cardioplegia in coronary artery bypass grafting led to higher inflammatory markers and rehospitalization rates compared to other techniques. These findings suggest caution with single-dose del Nido cardioplegia in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Myocardial Protection
Background:
- Single-dose cardioplegia is increasingly used in coronary artery bypass grafting (CABG).
- The optimal cardioplegic technique and its long-term efficacy, especially in high-risk patients, require further investigation.
- Understanding the time window for successful reperfusion and its impact on clinical outcomes is crucial.
Purpose of the Study:
- To compare the early and 30-day clinical outcomes of three different cardioplegic techniques in high-risk CABG patients.
- To evaluate the effectiveness of del Nido cardioplegia versus histidine-tryptophane-ketoglutarate and cold blood cardioplegia.
- To assess markers of myocardial protection and patient recovery post-surgery.
Main Methods:
- A prospective cohort study involving 312 high-risk patients undergoing CABG between January 2017 and June 2019.
- Patients received one of three cardioplegic strategies: single-dose del Nido (Group 1), single-dose histidine-tryptophane-ketoglutarate (Group 2), or cold blood cardioplegia (Group 3).
- Perioperative monitoring included memory loop recording for 30 days to document predefined clinical events.
Main Results:
- Group 1 (del Nido) showed significantly higher interleukin-6 and cardiac troponin levels post-cardiopulmonary bypass compared to Groups 2 and 3.
- The incidence of adverse events, indicative of inadequate myocardial protection, was significantly higher in Group 1.
- Group 1 experienced more frequent atrial fibrillation and a higher hospital readmission rate (17.6%) compared to Group 2 (9%) and Group 3 (8%).
Conclusions:
- Del Nido cardioplegia was associated with a more pronounced inflammatory response and elevated troponin levels.
- Single-dose del Nido cardioplegia in high-risk patients resulted in poorer longer-term outcomes, including more cardiac events and higher rehospitalization rates.
- These findings highlight the importance of selecting appropriate cardioplegic techniques for adjunct myocardial protection in high-risk CABG patients.
Background:
Despite the increasing popularity of single-dose cardioplegia techniques in coronary artery bypass grafting, the time window for successful reperfusion remains unclear. This study aimed to compare different cardioplegic techniques based on early and 30-day clinical outcomes via thorough monitoring.
Methods:
This prospective cohort study included high-risk patients undergoing coronary artery bypass grafting and receiving 3 different types of cardioplegia between January 2017 and June 2019. Group 1 (n = 101) had a single dose of del Nido cardioplegia, group 2 (n = 92) had a single dose of histidine-tryptophane-ketoglutarate, and group 3 (n = 119) had cold blood cardioplegia. Patients were examined perioperatively by memory loop recording and auto-triggered memory loop recording for 30 days, with documentation of predefined events.
Results:
Interleukin-6 and cardiac troponin levels in group 1 were significantly higher than those in groups 2 and 3. The incidence of predefined events as markers of inadequate myocardial protection was significantly higher group 1, with more frequent atrial fibrillation attacks and more hospital readmissions. The readmission rate was 17.6% in group 1, 9% in group 2, and 8% in group 3.
Conclusions:
Our data demonstrate the long-term efficacy of cardioplegic techniques, which may become more crucial in high-risk patients who genuinely have a chance to benefit from adjunct myocardial protection. Patients given del Nido cardioplegia had a significantly more prominent inflammatory response and higher troponin levels after cardiopulmonary bypass. This group had issues in the longer term with significantly more cardiac events and a higher rehospitalization rate.
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