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Patient Outcomes after Introduction of Novel Myocardial Protection Protocol for Prolonged Aortic Cross-Clamping

Masahide Komagamine1, Takuma Fukunishi1, Yoshiki Yamasaki1

  • 1Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
|June 11, 2025
PubMed

Insights

A revised myocardial protection protocol improved patient outcomes in cardiac surgery requiring prolonged aortic cross-clamping. The new protocol led to lower creatine kinase levels and shorter hospital stays, demonstrating safe and favorable results.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia
  • Myocardial Protection Strategies

Background:

  • Cardioplegia is crucial for patient outcomes in cardiac surgery.
  • Prolonged aortic cross-clamping presents challenges for myocardial protection.
  • Hospital protocol revisions aim to optimize clinical results.

Purpose of the Study:

  • To compare clinical outcomes of cardiac surgery patients with prolonged aortic cross-clamping before and after a myocardial protection protocol revision.
  • To evaluate the efficacy of a revised protocol in enhancing myocardial protection during extended cross-clamp times.

Main Methods:

  • Retrospective study of 36 patients undergoing cardiac surgery with >4h aortic cross-clamping (2018-2024).
  • Group 1: Pre-protocol revision (2018-March 2021).
  • Group 2: Post-protocol revision (April 2021-2024).

Main Results:

  • Group 2 showed significantly lower postoperative creatine kinase levels (P=0.018).
  • Group 2 experienced a significantly shorter hospital stay (P=0.017).
  • No statistically significant difference in new postoperative right-ventricular dysfunction between groups.

Conclusions:

  • The revised myocardial protection protocol is safe and effective for cardiac surgeries with prolonged aortic cross-clamping.
  • The protocol achieves favorable surgical results without altering the cardioplegia solution.
  • Optimized myocardial protection strategies can improve patient recovery post-cardiac surgery.
Abstract

Keywords:
cardiac surgeryclinical outcomesmyocardial protectionprolonged aortic cross-clamping

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