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Thorac Cardiovasc Surg 2020; 68(03): 223-231
DOI: 10.1055/s-0039-1687843
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Microplegia versus Cardioplexol® in Coronary Artery Bypass Surgery with Minimal Extracorporeal Circulation: Comparison of Two Cardioplegia Concepts

Autoren

  • Luca Koechlin

    1   Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland

  • Bejtush Rrahmani

    1   Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland

  • Brigitta Gahl

    1   Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland

  • Denis Berdajs

    1   Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland

  • Martin T.R. Grapow

    1   Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland

  • Friedrich S. Eckstein

    1   Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland

  • Oliver Reuthebuch

    1   Department of Cardiac Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland

Funding We have received no funding for this study.
Weitere Informationen

Publikationsverlauf

22. November 2018

13. März 2019

Publikationsdatum:
25. April 2019 (online)

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Abstract

Background The aim of this study is to compare the combined use of the Myocardial Protection System and our microplegia (Basel Microplegia Protocol) with Cardioplexol® in coronary artery bypass grafting using the minimal extracorporeal circulation.

Methods The analysis focused on propensity score matched pairs of patients in whom microplegia or Cardioplexol® was used. Primary efficacy endpoints were high-sensitivity cardiac troponin-T on postoperative day 1 and peak values during hospitalization. Furthermore, we assessed creatine kinase and creatinine kinase-myocardial type, as well as safety endpoints.

Results A total of 56 patients who received microplegia and 155 patients who received Cardioplexol® were included. The use of the microplegia was associated with significantly lower geometric mean (confidence interval) peak values of high-sensitivity cardiac troponin-T (233 ng/L [194–280 ng/L] vs. 362 ng/L [315–416 ng/L]; p = 0.001), creatinine kinase (539 U/L [458–633 U/L] vs. 719 U/L [645–801 U/L]; p = 0.011), and creatinine kinase-myocardial type (13.8 µg/L [9.6–19.9 µg/L] vs. 21.6 µg/L [18.9–24.6 µg/L]; p = 0.026), and a shorter length of stay on the intensive care unit (1.5 days [1.2–1.8 days] vs. 1.9 days [1.7–2.1 days]; p = 0.011). Major adverse cardiac and cerebrovascular events occurred with roughly equal frequency (1.8 vs. 5.2%; p = 0.331).

Conclusions The use of the Basel Microplegia Protocol was associated with lower peak values of high-sensitivity cardiac troponin-T, creatinine kinase, and creatinine kinase-myocardial type and with a shorter length of stay on the intensive care unit, as compared with the use of Cardioplexol® in isolated coronary artery bypass surgery using minimal extracorporeal circulation.

Keywords

cardiopulmonary bypass (CPB) - coronary artery bypass grafts surgery (CABG) - myocardial protection/cardioplegia - perfusion

Authors' Contributions

Author L.K.: study design, collection of data, data analysis/interpretation, and writing the manuscript; author B.R.: data collection and critical revision of the manuscript; author B.G.: study design, data collection, data analysis/interpretation, writing the manuscript, and critical revision of the manuscript; author DB: critical revision of the manuscript and operating surgeon; author MG: critical revision of the manuscript and operating surgeon; author FE: critical revision of manuscript and operating surgeon; author OR: study design, data analysis/interpretation, writing manuscript, critical revision of the manuscript, and operating surgeon.


Supplementary Material

 

  • References

  • 1 Cohen DJ, Osnabrugge RL, Magnuson EA. , et al; SYNTAX Trial Investigators. Cost-effectiveness of percutaneous coronary intervention with drug-eluting stents versus bypass surgery for patients with 3-vessel or left main coronary artery disease: final results from the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial. Circulation 2014; 130 (14) 1146-1157
    CrossrefPubMedSuche in Google Scholar
  • 2 Farkouh ME, Domanski M, Dangas GD. , et al; FREEDOM Follow-On Study Investigators. Long-term survival following multivessel revascularization in patients with diabetes: the FREEDOM follow-on study. J Am Coll Cardiol 2019; 73 (06) 629-638
    PubMedSuche in Google Scholar
  • 3 Sousa-Uva Miguel, Neumann Franz-Josef, Ahlsson Anders, Alfonso Fernando, Banning Adrian P, Benedetto Umberto. , et al. ESC/EACTS Guidelines on myocardial revascularization. European Journal of Cardio-Thoracic Surgery 2019; 55 (01) 4-90 , https://doi.org/10.1093/ejcts/ezy289
    CrossrefPubMedSuche in Google Scholar
  • 4 Anastasiadis K, Murkin J, Antonitsis P. , et al. Use of minimal invasive extracorporeal circulation in cardiac surgery: principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies International Society (MiECTiS). Interact Cardiovasc Thorac Surg 2016; 22 (05) 647-662
    CrossrefPubMedSuche in Google Scholar
  • 5 Puehler T, Haneya A, Philipp A. , et al. Minimal extracorporeal circulation: an alternative for on-pump and off-pump coronary revascularization. Ann Thorac Surg 2009; 87 (03) 766-772
    CrossrefPubMedSuche in Google Scholar
  • 6 Winkler B, Heinisch PP, Zuk G. , et al. Minimally invasive extracorporeal circulation: Excellent outcome and life expectancy after coronary artery bypass grafting surgery. Swiss Med Wkly 2017; 147: w14474
    PubMedSuche in Google Scholar
  • 7 Philipp A, Schmid FX, Foltan M. , et al. Miniaturisierte extrakorporale kreislaufsysteme: Erfahrungsbericht aus über 1000 anwendungen. Kardiotechnik 2006; 15 (01) 3-8
    Suche in Google Scholar
  • 8 van Boven WJ, Gerritsen WB, Waanders FG, Haas FJ, Aarts LP. Mini extracorporeal circuit for coronary artery bypass grafting: initial clinical and biochemical results: a comparison with conventional and off-pump coronary artery bypass grafts concerning global oxidative stress and alveolar function. Perfusion 2004; 19 (04) 239-246
    CrossrefPubMedSuche in Google Scholar
  • 9 Panday GFV, Fischer S, Bauer A. , et al. Minimal extracorporeal circulation and off-pump compared to conventional cardiopulmonary bypass in coronary surgery. Interact Cardiovasc Thorac Surg 2009; 9 (05) 832-836
    CrossrefPubMedSuche in Google Scholar
  • 10 Reuthebuch O, Koechlin L, Gahl B. , et al. Off-pump compared to minimal extracorporeal circulation surgery in coronary artery bypass grafting. Swiss Med Wkly 2014; 144: w13978
    PubMedSuche in Google Scholar
  • 11 Pagano D, Milojevic M, Meesters MI. , et al. EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery: the task force on patient blood management for adult cardiac surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiot. Eur J Cardiothorac Surg 2017; 53 (2018): 79-111
    Suche in Google Scholar
  • 12 Kairet K, Deen J, Vernieuwe L, de Bruyn A, Kalantary S, Rodrigus I. Cardioplexol®, a new cardioplegic solution for elective CABG. J Cardiothorac Surg 2013; 8 (Suppl. 01) P120
    CrossrefSuche in Google Scholar
  • 13 Matt P, Arbeleaz E, Schwirtz G, Doebele T, Eckstein F. Low-Volume, Single-Shot Crystalloid Cardioplegia is Safe for Isolated Aortic Valve Replacement. Thorac Cardiovasc Surg 2012; 60 (05) 360-362
    Thieme ConnectPubMedSuche in Google Scholar
  • 14 Tschopp S, Eckstein F, Matt P. Low-volume cardioplegia and myocardial protection in coronary artery bypass graft surgery. Thorac Cardiovasc Surg 2018 ; (e-pub ahead of print) doi:10.1055/s-0038-1667322
    PubMedSuche in Google Scholar
  • 15 Koechlin L, Zenklusen U, Doebele T. , et al. Clinical implementation of a novel myocardial protection pathway in coronary artery bypass surgery with minimal extracorporeal circulation. Perfusion 2018 ; (e-pub ahead of print) doi:10.1177/0267659118815287
    PubMedSuche in Google Scholar
  • 16 Gerdisch MW, Robinson S, David G, Makepeace S, Ryan MP, Gunnarsson C. Clinical and economic benefits of advanced microplegia delivery system in cardiac surgery: evidence from 250 hospitals. J Comp Eff Res 2018; 7 (07) 673-683
    CrossrefPubMedSuche in Google Scholar
  • 17 Algarni KD, Weisel RD, Caldarone CA, Maganti M, Tsang K, Yau TM. Microplegia during coronary artery bypass grafting was associated with less low cardiac output syndrome: a propensity-matched comparison. Ann Thorac Surg 2013; 95 (05) 1532-1538
    CrossrefPubMedSuche in Google Scholar
  • 18 Matt P, Arbeleaz E, Schwirtz G, Doebele T, Eckstein F. Low-volume, single-shot crystalloid cardioplegia is safe for isolated aortic valve replacement. Thorac Cardiovasc Surg 2012; 60 (05) 360-362
    Thieme ConnectPubMedSuche in Google Scholar
  • 19 Kuhn EW, Liakopoulos O, Slottosch I. , et al. Buckberg versus Calafiore cardioplegia in patients with acute coronary syndromes. Thorac Cardiovasc Surg 2018; 66 (06) 457-463
    Thieme ConnectPubMedSuche in Google Scholar
  • 20 Gahl B, Göber V, Odutayo A. , et al. Prognostic value of early postoperative troponin T in patients undergoing coronary artery bypass grafting. J Am Heart Assoc 2018; 7 (05) e007743
    PubMedSuche in Google Scholar
  • 21 Mauermann E, Bolliger D, Fassl J. , et al. Association of troponin trends and cardiac morbidity and mortality after on-pump cardiac surgery. Ann Thorac Surg 2017; 104 (04) 1289-1297
    CrossrefPubMedSuche in Google Scholar
  • 22 Mauermann E, Bolliger D, Fassl J. , et al. Postoperative high-sensitivity troponin and its association with 30-day and 12-month, all-cause mortality in patients undergoing on-pump cardiac surgery. Anesth Analg 2017; 125 (04) 1110-1117
    CrossrefPubMedSuche in Google Scholar
  • 23 de Lemos JA, Drazner MH, Omland T. , et al. Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population. JAMA 2010; 304 (22) 2503-2512
    CrossrefPubMedSuche in Google Scholar
  • 24 McQueen MJ, Kavsak PA, Xu L, Shestakovska O, Yusuf S. Predicting myocardial infarction and other serious cardiac outcomes using high-sensitivity cardiac troponin T in a high-risk stable population. Clin Biochem 2013; 46 (1,2): 5-9
    CrossrefPubMedSuche in Google Scholar
  • 25 Devereaux PJ, Biccard BM, Sigamani A. , et al; Writing Committee for the VISION Study Investigators. Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA 2017; 317 (16) 1642-1651
    CrossrefPubMedSuche in Google Scholar
  • 26 Everett BM, Brooks MM, Vlachos HEA, Chaitman BR, Frye RL, Bhatt DL. ; BARI 2D Study Group. Troponin and cardiac events in stable ischemic heart disease and diabetes. N Engl J Med 2015; 373 (07) 610-620
    CrossrefPubMedSuche in Google Scholar