Vol. 22 No. 4 (2018)
CORONARY ARTERY DISEASES

Intermittent warm blood cardioplegia versus crystalloid cardioplegia in coronary artery bypass grafting surgery patients: Is there any difference in the early postoperative period?

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  • V. Bazylev,
  • M. Evdokimov,
  • A. Gornostaev,
  • A. Schegolykov,
  • A. Bulygin
V. Bazylev
Federal Center of Cardiovascular Surgery (Penza), Ministry of Health of Russian Federation, Penza, Russian Federation
M. Evdokimov
Federal Center of Cardiovascular Surgery (Penza), Ministry of Health of Russian Federation, Penza, Russian Federation
A. Gornostaev
Federal Center of Cardiovascular Surgery (Penza), Ministry of Health of Russian Federation, Penza, Russian Federation
A. Schegolykov
Federal Center of Cardiovascular Surgery (Penza), Ministry of Health of Russian Federation, Penza, Russian Federation
Bio
A. Bulygin
Federal Center of Cardiovascular Surgery (Penza), Ministry of Health of Russian Federation, Penza, Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2018-4-64-71

Published 2018-12-29

Keywords

  • clinical outcomes,
  • cold crystalloid cardioplegia,
  • intermittent warm blood cardioplegia,
  • myocardial protection

How to Cite

Bazylev, V., Evdokimov, M., Gornostaev, A., Schegolykov, A., & Bulygin, A. (2018). Intermittent warm blood cardioplegia versus crystalloid cardioplegia in coronary artery bypass grafting surgery patients: Is there any difference in the early postoperative period?. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 22(4), 64–71. https://doi.org/10.21688/1681-3472-2018-4-64-71

Copyright (c) 2018 Bazylev V. V., Evdokimov M. E., Gornostaev A. A., Schegolykov A. A., Bulygin A. V.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim. The purpose of this study was to assess the effectiveness of two types of cardioplegia solutions, namely, blood and crystalloid cardioplegia in terms of clinical outcomes in patients undergoing coronary artery bypass grafting.

Methods. The retrospective study recruited 2,539 coronary artery bypass grafting patients, with 1,070 (45%) of them receiving crystalloid and 1,289 (55%) blood cardioplegia as a primary cardioplegic agent. Propensity score matching was performed to create comparable patient groups. The primary endpoint of the study was hospital mortality and different postoperative outcomes.

Results. Patients receiving blood cardioplegia versus those with crystalloid cardioplegia were found out to have higher rate of acute kidney injury (15.7% vs 11.8%; OR=0.72; p=0.01) and postoperative ventilatory support (Ме=5:35 vs Me=5; p<0.05). During ventilatory support, the crystalloid cardioplegia patients demonstrated lower hemoglobin (Me=65 g/l vs Me=74 g/l; p<0.01) and hematocrit (Me=21% vs Mе=24%; p<0.01). Intraoperatively, packed red blood cells were administered in blood cardioplegia patients by 30% more often than in crystalloid cardioplegia ones (24% vs 19.6%; OR=0.77; p=0.02). Patients receiving crystalloid cardioplegia had a greater postoperative fluid balance (Me=1,700 ml vs Mе=1,350 ml; p<0.01) more frequent use of inotrope and vasopressor therapy (4.5% vs 2.8%; OR=1.64; p=0.04) and a longer stay in intensive care unit (p<0.01).
No statistically significant differences were observed concerning perioperative and postoperative myocardial infarction, low cardiac output syndrome or intra-aortic balloon pumping, allogeneic blood transfusions in the postoperative period, episodes of atrial fibrillation, gastrointestinal complications, reoperation due to any cause, length of stay in hospital, hospital mortality.

Conclusion. Blood cardioplegia might decrease the need in inotrope and vasopressor therapy, length of stay in intensive care unit, but it increases the rate of acute kidney injury, risk of allogeneic blood transfusions and durability of postoperative ventilatory support. 

Received 1 August 2018. Revised 18 October 2018. Accepted 22 October 2018.

Funding: The study did not have sponsorship.

Conflict of interest: Authors declare no conflict of interest.

Author contributions
Conception and study design: M.E. Evdokimov, A.A. Gornostaev, V.V. Bazylev
Data collection and analysis: M.E. Evdokimov, A.A. Gornostaev, A.A. Schegolkov, A.V. Bulygin
Statistical analysis: A.A. Schegolkov, A.V. Bulygin
Drafting the article: A.A. Schegolkov, A.V. Bulygin
Critical revision of the article: M.E. Evdokimov, A.A. Gornostaev, V.V. Bazylev
Final approval of the version to be published: V.V. Bazylev, M.E. Evdokimov, A.A. Gornostaev, A.A. Schegolkov, A.V. Bulygin

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References

  1. Ferguson T.B., Hammill B.G., Peterson E.D., DeLong E.R., Grover F.L. A decade of change—risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990–1999: a report from the STS National Database Committee and the Duke Clinical Research Institute. The Annals of Thoracic Surgery. 2002;73(2):480-9. PMID: 11845863.
  2. Hausenloy D.J., Boston-Griffiths E., Yellon D.M. Cardioprotection during cardiac surgery. Cardiovascular Research. 2012;94(2):253-65. PMCID: PMC3331616, PMID: 22440888. https://doi.org/10.1093/cvr/cvs131
  3. Sá M.P., Rueda F.G., Ferraz P.E., Chalegre S., Vasconcelos F.P., Lima R.C. Is there any difference between blood and crystalloid cardioplegia for myocardial protection during cardiac surgery? A meta-analysis of 5576 patients from 36 randomized trials. Perfusion. 2012;27(6):535-46. PMID: 22851314. https://doi.org/10.1177/0267659112453754
  4. Базылев В.В., Евдокимов М.Е., Россейкин Е.В., Пантюхина М.А., Кокашкин М.В. Сравнение эффективности тепловой прерывистой кровяной кардиоплегии (KMgLid-кровь) и фармакохолодовой кристаллоидной (HTK-раствор) кардиоплегии при открытых операциях прямой реваскуляризации миокарда. Анестезиология и реаниматология. 2018;63(2):160-164. [Basylev V.V., Evdokimov M.E., Rosseikin E.V., Pantyuhina M.A., Kokashkin M.V. Comparing the efficacy of HTK-solution to modified techni queofintermittent warm blood cardioplegiainadult patients undergoing isolated CABG. Russian Journal of Anesthesiology and Reanimatology. 2018;63(2):160-164.] https://doi.org/10.18821/0201-7563-2018-63-2-160-164
  5. Thygesen K., Alpert J. S., Jaffe A. S., Simoons M.L., Chaitman B.R., White H.D., Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, Thygesen K., Alpert J.S., White H.D., Jaffe A.S., Katus H.A., Apple F.S., Lindahl B., Morrow D.A., Chaitman B.A., Clemmensen P.M., Johanson P, Hod H., Underwood R., Bax J.J., Bonow R.O., Pinto F., Gibbons R.J., Fox K.A., Atar D., Newby L.K., Galvani M., Hamm C.W., Uretsky B.F., Steg P.G., Wijns W., Bassand J.P., Menasché P., Ravkilde J., Ohman E.M., Antman E.M., Wallentin L.C., Armstrong P.W., Simoons M.L., Januzzi J.L., Nieminen M.S., Gheorghiade M., Filippatos G., Luepker R.V., Fortmann S.P., Rosamond W.D., Levy D., Wood D., Smith S.C., Hu D., Lopez-Sendon J.L., Robertson R.M., Weaver D., Tendera M., Bove A.A., Parkhomenko A.N., Vasilieva E.J., Mendis S.; ESC Committee for Practice Guidelines (CPG). Third universal definition of myocardial infarction. European Heart Journal. 2012;33(20):2551-67. PMID: 22922414. https://doi.org/10.1093/eurheartj/ehs184
  6. Lomivorotov V.V., Efremov S.M., Kirov M.Y., Fominskiy E.V., Karaskov A.M. Low-cardiac-output syndrome after cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2017;31(1):291-308. PMID: 27671216. https://doi.org/10.1053/j.jvca.2016.05.029
  7. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice. 2012;120(4):179-84. PMID: 22890468. https://doi.org/10.1159/000339789
  8. Rosenbaum P., Rubin D. The Central Role of the Propensity Score in Observational Studies for Causal Effects. Biometrika. 1983;70(1):41-55. https://doi.org/10.2307/2335942
  9. Øvrum E., Tangen G., Tølløfsrud S., Øystese R., Ringdal M.A., Istad R. Cold blood cardioplegia versus cold crystalloid cardioplegia: a prospective randomized study of 1440 patients undergoing coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery. 2004;28(6):860-5. PMID: 15573070. https://doi.org/10.1016/j.jtcvs.2004.03.032
  10. De Jonge M., Van Boxtel A.G., Soliman Hamad M.A., Mokhles M.M, Bramer S., Osnabrugge R.L.J, Berreklouw E. Intermittent warm blood versus cold crystalloid cardioplegia for myocardial protection: a propensity score-matched analysis of 12-year single-center experience. Perfusion. 2015;30(3):243-9. PMID: 24969571. https://doi.org/10.1177/0267659114540023
  11. Martin T.D., Craver J.M., Gott J.P., Weintraub W.S., Ramsay J., Mora C.T., Guyton R.A. Prospective, randomized trial of retrograde warm blood cardioplegia: myocardial benefit and neurologic threat. The Annals of Thoracic Surgery. 1994;57(2):298-304. PMID: 8311588.
  12. Flack J.E. 3rd, Cook J.R., May S.J, Lemeshow S., Engelman R.M., Rousou J.A., Deaton D.W. Does cardioplegia type affect outcome and survival in patients with advanced left ventricular dysfunction? Results from the CABG Patch Trial. Circulation. 2000;102(19 Suppl 3):III84-9. PMID: 11082368.
  13. Guru V., Omura J., Alghamdi A.A., Weisel R., Fremes S.E. Is blood superior to crystalloid cardioplegia? A meta-analysis of randomized clinical trials. Circulation. 2006;114(1):I331-8. PMID: 16820596. https://doi.org/10.1161/CIRCULATIONAHA.105.001644
  14. Zeng J., He W., Qu Z., Tang Y., Zhou, Q., Zhang B. Cold blood versus crystalloid cardioplegia for myocardial protection in adult cardiac surgery: a meta-analysis of randomized controlled studies. Journal of Cardiothoracic and Vascular Anesthesia. 2014;28(3):674-81. PMID: 24721161. https://doi.org/10.1053/j.jvca.2013.06.005