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Do we correctly calculate doses of cardioplegia during aortic valve replacement procedures? A preliminary report
Aleksandra Sucharska1, Agnieszka Adamowska1, Zuzanna Karbowska1
1Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
Insights
Optimizing cardioplegia volume indexed for left ventricular mass during aortic valve replacement improves myocardial protection and long-term survival. Standard body mass calculations may be insufficient for effective patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiopulmonary Bypass
Background:
- Intraoperative myocardial protection is critical for successful aortic valve replacement (AVR) in patients with aortic stenosis (AS).
- Current cardioplegia dosing often relies on patient body mass, a method whose universal applicability is questioned.
Purpose of the Study:
- To evaluate whether standard body mass-based cardioplegia dosing is optimal for all AS patients undergoing AVR.
- To investigate the relationship between indexed cardioplegia volume, myocardial injury, and long-term survival after AVR.
Main Methods:
- Ninety-four patients undergoing elective isolated AVR with cold cardioplegic arrest were studied.
- Patients were divided into high (above median) and low (below median) cardioplegia volume groups, indexed for left ventricular mass (LVM).
- Myocardial injury was assessed by maximal postoperative cardiac troponin I (cTnI max) release; long-term survival was analyzed using Kaplan-Meier methods.
Main Results:
- Higher indexed cardioplegia volumes correlated with lower cTnI max levels (r = 0.345).
- Group A (high cardioplegia volume) exhibited significantly lower cTnI max compared to Group B (low volume) (medians: 14.918 vs. 9.876 μg/l; p = 0.005).
- Five-year survival was significantly better in the high-volume group (95.7%) versus the low-volume group (82.6%; p = 0.044).
Conclusions:
- Relying solely on body mass for cardioplegia dosing in AVR may be suboptimal.
- Adjusting cardioplegia volume indexed to left ventricular mass can enhance myocardial protection.
- Optimized cardioplegia strategies significantly impact postoperative outcomes and long-term survival in AS patients undergoing AVR.
Introduction:
Intraoperative myocardial protection during aortic valve replacement (AVR) for aortic stenosis (AS) is of paramount importance for outcomes. The dose of cardioplegia is usually calculated with reference to body mass.
Aim:
To assess whether such a strategy should be applied to all AS patients undergoing AVR.
Material And Methods:
The study included 94 patients who underwent elective isolated AVR in cardiopulmonary bypass with cold cardioplegic arrest, with a mean age of 65.4 ±7.8 years. They were divided into two subgroup: A with an infusion of high (above median) and subgroup B with a low (below median) volume of cardioplegia indexed for left ventricular mass (LVM). Their doses were referred to the maximal postoperative release of cardiac troponin I (cTnI max). Eventually, it was examined whether the extent of intraoperative myocardial injury translated into long-term survival stratified according to the Kaplan-Meier method.
Results:
The mean volume of cardioplegia was 1381 ±279 ml (4.9 ±1.6 ml/g of LV myocardium). cTnI max was much higher in group A than in group B (medians: 14.918 vs. 9.876 μg/l; p = 0.005). Moreover, a negative correlation between the index cardioplegia volume and cTnI max (r = 0.345) was noted. The five-year probability of survival in subgroup A (95.7%) was significantly better than that in subgroup B individuals (82.6%, p = 0.044).
Conclusions:
Calculating cardioplegic doses during AVR solely based on body mass may be suboptimal and have a significant impact on postoperative outcomes.
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