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Thorac Cardiovasc Surg 2024; 72(07): 489-497
DOI: 10.1055/a-2141-8105
Original Cardiovascular

Determinants of Inadequate Cardioprotection in Adult Patients with Left Ventricular Dysfunction

Krzysztof Sanetra
1   Division of Cardiovascular Surgery, Andrzej Frycz Modrzewski Krakow University, Bielsko-Biała, Poland
2   Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
,
Witold Gerber
2   Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
3   Department of Cardiac Surgery, Academy of Silesia, Katowice, Poland
,
Piotr Paweł Buszman
4   Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
5   Department of Cardiology, Andrzej Frycz Modrzewski Krakow Univeristy, Krakow, Poland
6   Department of Cardiology, American Heart of Poland, Bielsko- Biala, Poland
,
Marta Mazur
5   Department of Cardiology, Andrzej Frycz Modrzewski Krakow Univeristy, Krakow, Poland
,
Krzysztof Milewski
4   Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
6   Department of Cardiology, American Heart of Poland, Bielsko- Biala, Poland
7   Department of Cardiology, Academy of Silesia, Katowice, Poland
,
Paweł Kaźmierczak
8   American Heart of Poland, Katowice, Poland
,
Andrzej Bochenek
2   Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
3   Department of Cardiac Surgery, Academy of Silesia, Katowice, Poland
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Abstract

Background Perioperative cardioprotection is essential for achieving satisfactory clinical outcomes in heart failure patients. It is important to understand 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 hours 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, anemic 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).

Conclusion The use of CB cardioplegia may be beneficial in anemic patients, whereas the use of DN cardioplegia may be beneficial for expected long CCT and high leukocytosis.

Keywords

cardioprotection - cardioplegia - heart failure - cardiopulmonary bypass

Data Availability Statement

The article's data can be shared on reasonable request to the corresponding author.




Publication History

Received: 14 February 2023

Accepted: 25 July 2023

Accepted Manuscript online:
26 July 2023

Article published online:
29 August 2023

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