Abstract 19558: Elective Cardiac Arrest With HTK-Bretschneider Solution or Blood Cardioplegia According to Calafiore in Complex Triple Valve Surgery: A Single Center Experience
Introduction: Evidence on outcome of complex cardiac surgery such as triple valve surgery (TVS) with concomitant procedures depending on the cardioplegic solution is scarce.
Hypothesis: Myocardial protection with crystalloid (HTK) or cold blood cardioplegia influences surgical outcome after complex cardiac surgery like TVS.
Methods: Screening of our institutional data-base with prospectively entered data identified 471 consecutive patients (mean age 70.3±9.2 years; 50.9% male), who underwent TVS (replacement or repair of aortic, mitral and tricuspid valve) between 12/1994 and 01/2013. In the majority of patients cardiac arrest was induced with HTK- Bretschneider solution (HTK, Custodiol®, n=277, 58.8%), whereas in 41.1% (n=194) cold blood cardioplegia (BCP) according to Calafiore was administered. Data were analyzed retrospectively rendering the cardioplegic solution. Furthermore, patients with recent myocardial infarction (MI), coronary artery disease (CAD), concomitant CABG or reduced left ventricular ejection fraction (HFrEF≤40%) were examined.
Results: Preoperative patient characteristics and comorbidities were equally distributed (mean age HTK: 70.4±8.6, BCP 70.1±8.9; p=0.9) except for history of recent MI (HTK: 6.4%, BCP: 14.1%; p=0.008). Neither 30-day mortality (HTK: 16.2%; BCP: 18.2%; p=0.619) nor overall 1-year survival (HTK: 74%; BCP: 72.1%; p=0.673) were significantly different. CABG was observed more frequently in BCP (HTK: 19.9%; BCP: 29.9%; p=0.015). Incidence of the cumulative endpoint (30 day mortality, MI, arrhythmia, LCOS or need for permanent pacemaker implantation) was also comparable (HTK: 47.6%; BCP: 54.8%, p=0.149). Early mortality for the different subgroups was comparable for patients with recent MI (p=1.000), CAD (p=0.435) or concomitant CABG (p=0.519). In patients with HFrEF hospital mortality was higher in the HTK group (HTK 18/71 22.5%; BCP 5/50 10%; p=0.037), while long-term survival was not different (p=0.655).
Conclusions: Elective cardiac arrest with HTK shows equivalent outcome compared to BCP during TVS, even when extended cardiac arrest is required. In patients presenting with HFrEF BCP seems to provide improved hospital survival.
Author Disclosures: A.A. Hoyer: None. T. Noack: None. P. Kiefer: None. D.M. Holzhey: None. S. Lehmann: None. J. Garbade: None. F. Bakhtiary: None. M. Misfeld: None. J. Seeburger: None. F.W. Mohr: None.
- © 2016 by American Heart Association, Inc.