Blood versus crystalloid cardioplegia during triple valve surgery: A single center experience
Alexandro Hoyer1, Thilo Noack1, Philipp Kiefer1
1Department of Cardiac Surgery at Heart Center Leipzig, University of Leipzig GmbH Universitatsklinik, Saxony, Germany.
Insights
Crystalloid (HTK-Bretschneider) and blood (Calafiore) cardioplegia show similar outcomes for triple valve surgery (TVS). However, patients with reduced left ventricular function may benefit from blood cardioplegia during TVS.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardioplegia Solutions
Background:
- Limited data exists on cardioplegia efficacy in complex cardiac operations like triple valve surgery (TVS).
- This study compares outcomes using crystalloid (Bretschneider) versus blood (Calafiore) cardioplegia in TVS patients.
Purpose of the Study:
- To compare the efficacy of crystalloid (HTK-Bretschneider) and blood (Calafiore) cardioplegia solutions in patients undergoing triple valve surgery (TVS).
- To evaluate perioperative and follow-up outcomes associated with each cardioplegia type in TVS.
Main Methods:
- Retrospective analysis of 471 consecutive TVS patients (December 1994 - January 2013).
- Patients received either HTK-Bretschneider solution (n=277) or Calafiore blood cardioplegia (n=194).
- Outcomes including mortality, myocardial infarction, and survival were compared between groups.
Main Results:
- 30-day mortality and cumulative endpoints were similar between HTK and blood cardioplegia groups.
- Patients with reduced left ventricular ejection fraction (LVEF <40%) had higher 30-day mortality with HTK (22.5%) compared to blood cardioplegia (10%).
- Five-year survival rates were comparable (52% HTK vs. 55% blood).
Conclusions:
- HTK-Bretschneider cardioplegia demonstrates equivalent outcomes to Calafiore blood cardioplegia in TVS.
- Blood cardioplegia may offer a survival benefit for TVS patients with pre-existing reduced left ventricular function.
Background:
The efficacy of different cardioplegia solutions on outcomes of complex cardiac operations such as triple valve surgery (TVS) is scarce. Here we compared the outcomes in TVS patients receiving either crystalloid (Bretschneider) or blood (Calafiore) cardioplegia.
Methods:
Screening of our institutional database with prospectively entered data identified 471 consecutive patients (mean age 70.3 ± 9.2 years; 50.9% male), who underwent TVS (replacement or repair of aortic, mitral and tricuspid valve) between December 1994 and January 2013. In 277 patients, cardiac arrest was induced with HTK-Bretschneider solution (HTK, n = 277, 58.8%), whereas 194 received cold blood cardioplegia (BCP) according to Calafiore (n = 194, 41.2%). Comparisons of perioperative and follow up outcomes were made between cardioplegia groups.
Results:
Preoperative patient characteristics and comorbidities were equally balanced between groups. 30-days mortality was similar between groups (HTK: 16.2%; BCP: 18.2%; p = 0.619). Incidence of the cumulative endpoint (30days mortality, myocardial infarction (MI), arrhythmia, low cardiac output syndrome or need for permanent pacemaker implantation) was also comparable (HTK: 47.6%; BCP: 54.8%, p = 0.149). In patients with reduced left ventricular ejection fraction (LVEF <40%), 30days mortality was higher in the HTK group (HTK 18/71 22.5%; BCP 5/50 10%; p = 0.037). Five-year survival was similar between groups (52 ± 6% for HTK and 55 ± 5% for BCP patients). In-Hospital mortality was best predicted by length of surgery and reperfusion ratio. Decreased age, shorter bypass time, preserved LVEF and concomitant surgical procedures have been found to be protective from long-term mortality.
Conclusions:
Myocardial protection with HTK shows equivalent outcomes compared to BCP during TVS. Patients with reduced left ventricular function may benefit from BCP during TVS.
