Does cardioplegia type affect outcome and survival in patients with advanced left ventricular dysfunction? Results from the CABG Patch Trial

Background-There is controversy regarding which cardioplegic solution, temp erature, and route of administration provides superior protection. The CABG Patch Trial enrolled a high-risk group of coronary artery disease patients with an ejection fraction of <36%. Thus, they constitute an ideal group to benefit most from optimal cardioplegic protection. Methods and Results-All patients randomized into the trial were compared wi th respect to the use of blood and crystalloid cardioplegia, In addition, a questionnaire was sent to surgeons requesting blood cardioplegic temperatu re and route. Patients receiving crystalloid cardioplegia versus those rece iving blood cardioplegia were found to have significantly more operative de aths (2% versus 0.3%, P=0.02), postoperative myocardial infarctions (10% ve rsus 2%, P<0.001), shock (13% versus 7%, P=0.013), and postoperative conduc tion defects (21.6% versus 12.4%, P=0.001). Despite this, early death (6% c rystalloid versus 4% blood cardioplegia) and late death (24% crystalloid ve rsus 21% blood cardioplegia) statistics were not significantly different. P atients receiving normothermic blood had less postoperative right ventricul ar dysfunction (10%) than did patients receiving cold blood (25%) or cold b lood with warm reperfusion (30%) (P=0.004). There was no significant differ ence in early or late death. Finally, patients who received combined antegr ade and retrograde cardioplegia had significantly less inotrope use (71% ve rsus 84%, P=0.002), right ventricular dysfunction (23% versus 41%, P=0.001) , and postoperative balloon pump use (13% versus 19%, P=0.02) than did thos e who received antegrade cardioplegia. There was no difference in survival. Conclusions-Blood cardioplegia and combined antegrade and retrograde cardio plegia are superior to crystalloid and antegrade cardioplegia alone for pos toperative morbidity. Despite this, there is no significant difference in e arly or late survival.