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

Abstract

<p><strong>Aim.</strong> 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.</p><p><strong>Methods.</strong> 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.</p><p><strong>Results.</strong> 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).<br />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.</p><p><strong>Conclusion.</strong> 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. </p><p>Received 1 August 2018. Revised 18 October 2018. Accepted 22 October 2018.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: M.E. Evdokimov, A.A. Gornostaev, V.V. Bazylev<br />Data collection and analysis: M.E. Evdokimov, A.A. Gornostaev, A.A. Schegolkov, A.V. Bulygin<br />Statistical analysis: A.A. Schegolkov, A.V. Bulygin<br />Drafting the article: A.A. Schegolkov, A.V. Bulygin<br />Critical revision of the article: M.E. Evdokimov, A.A. Gornostaev, V.V. Bazylev<br />Final approval of the version to be published: V.V. Bazylev, M.E. Evdokimov, A.A. Gornostaev, A.A. Schegolkov, A.V. Bulygin</p>