INTERMITTENT ANTEGRADE WARM BLOOD CARDIOPLEGIA IN AORTIC-VALVE REPLACEMENT

Background: Intermittent antegrade warm blood cardioplegia (IAWBC) is a well established technique of myocardial protection for coronary art ery surgery with metabolic and experimental basis. Methods: To evaluat e its effectiveness in aortic valve replacement (AVR), we compared 171 consecutive patients who underwent first AVR using IAWBC (group A) wi th the last 100 consecutive patients who underwent first AVR using int ermittent antegrade cold blood cardioplegia (IACBC) (group B). The end points considered were myocardial protection related (recovery of spon taneous rhythm, need for mechanical support, incidence of tow-output s yndrome, perioperative Q wave myocardial infarct, CK-MB levels, ventri cular arryhthmias and lidocaine infusion requirement, cardiac-related deaths, and death for any cause) and temperature perfusion related (bl eeding, awaking time, time to extubation, and cerebrovascular accident s). Results: Mortality was similar in both groups, but no patient in g roup A died for cardiac-related cause (0 vs 4, p < 0.01). More patient s in group A recovered a spontaneous rhythm (144 vs 47, p < 0.0001). I ncidence of low-output syndrome was higher in group B (16 vs 3, p < 0. 0005), as well as ventricular arryhthmias incidence and need for lidoc aine infusion (respectively 15 vs 2, p < 0.0001, and 10 vs 1, p < 0.00 05). Awaking time was shorter in warm patients (2.5 +/- 2.5 hours vs 4 .4 +/- 3.7 hours, p < 0.0005), as the extubation time (9.4 +/- 7.7 hou rs vs 13.5 +/- 11.7 hours, p < 0.0005) and bleeding (803 +/- 714 mL/24 hours vs 1051 +/- 1375 mL/24 hours, p < 0.05). As a consequence, the intensive care unit and the postoperative hospital stays were shorter in group A (32 +/- 27 hours vs 48 +/- 20 hours, p < 0.0005, and 7.2 +/ - 3.1 days vs 11.3 +/- 5.4 days, p < 0.0001, respectively). Conclusion s: IAWBC provides lower cardiac-related mortality and morbidity in pat ients who undergo AVR in comparison with lACBC.