Determinants of Inadequate Cardioprotection in Adult Patients with Left Ventricular Dysfunction

Abstract

Background: Perioperative cardioprotection is essential for achieving satisfactory clinical outcomes in heart failure patients. It is important to understanding the factors affecting perioperative cardioprotection. Methods: The institutional database was searched for patients with reduced ejection fraction (EF, < 40%) who underwent surgery with cardioplegia-induced arrest. Patients were divided into del Nido cardioplegia (DN) and cold blood cardioplegia (CB) groups. The relationships between age, preoperative blood parameters, creatinine, cross-clamp time (CCT), extracorporeal circulation time (ECT), and postoperative troponin values at 12 h or deterioration of EF (≥ 5%) were evaluated. Baseline characteristics, operative parameters, and outcomes were analyzed. Results: There were 508 patients with reduced EF (331 DN and 177 CB). In the entire cohort, anaemic patients had greater troponin values (p = 0.004), as well as in the DN group (p = 0.002). However, this was not detected in the CB group (flat regression line; p = 0.674). Patients with high leukocyte values had greater troponin release (entire cohort: p < 0.001; DN group: p < 0.001; CB group: steep regression line with p = 0.042). Longer CCT and ECT were associated with greater troponin release (entire cohort; both groups) and greater risk of fall in EF. In a direct comparison, fewer patients had significant deterioration of EF in the DN group than CB group (3.9% vs 11.9%; p < 0.001). Conclusions: The use of CB cardioplegia may be beneficial in anaemic patients, while the use of DN cardioplegia may be beneficial for expected long CCT and high leucocytosis.