Abstract
Background Choice of cardioplegic solution plays a pivotal role in special subgroups of patients
referred for on-pump cardiac surgery. This retrospective analysis aimed to assess
the impact of intermittent warm (Calafiore, Cala) versus intermittent cold blood cardioplegia
(Buckberg, Buck) in patients referred to coronary artery bypass graft (CABG) surgery
due to acute coronary syndromes (ACS).
Methods From 2008 to 2015, all consecutive patients undergoing urgent on-pump CABG surgery
due to ACS (n = 950) were retrospectively analyzed. Intraoperative cardiac arrest was achieved
using Buck (n = 273) or Cala (n = 677). Patients were compared regarding clinical outcomes and perioperative myocardial
injury (PMI). Propensity score matching was performed to control for differences in
preoperative patient characteristics.
Results Prevalences of left main stenosis >50%, COPD, and advanced New York Heart Association
(NYHA) class were higher for intermittent warm blood cardioplegia (IWC)-patients while
more Buck-patients had preoperative intra-aortic balloon pump (IABP) and redo procedures.
Buck-patients needed more intraoperative defibrillations and showed longer cardiopulmonary
bypass (CPB) and aortic clamping times. 30-day all-cause mortality (10.6 versus 9.3%),
major adverse cardiac events (MACE) (52.7 versus 48.6%), and PMI (50.5 versus 55.7%;
all p > 0.05) rates were comparable for Buck- and Cala-patients. Propensity score matching
resulted in equal group sizes (n = 212 each) and balanced distribution of preoperative covariates. Although more Buck-patients
still needed inotropic support >24 hours postoperatively (25.7 versus 14.7%; p = 0.005) compared with Cala-group, outcome variables of interest did not differ between
treatment groups (30-day mortality: 7.5 versus 9.0%; MACE: 49.5 versus 40.6%; PMI:
48.1 versus 37.3%; all p > 0.05).
Conclusion Buckberg and Calafiore cardioplegia offer comparable myocardial protection and similar
postoperative results in patients undergoing CABG surgery due to ACS.
Keywords
myocardial protection/cardioplegia - cardiopulmonary bypass - CPB - coronary artery
bypass grafts surgery - CABG
