Impact of myocardial protection during coronary bypass surgery on patient outcome

We have recently shown that continuous coronary perfusion with warm blood e nriched with the ultra-short acting B-blocker Esmolol (ES) improves functio nal and structural myocardial protection during coronary artery surgery as compared with conventional cardioplegia (CP). The purpose of the present st udy was to compare both myocardial protection techniques in terms of patien t outcome. We retrospectively analyzed the charts of 150 consecutive patien ts subjected to coronary artery surgery using the ES-technique: 150 patient s matched for age, gender, preoperative left ventricular function, history of renal failure, and history of neurological symptoms undergoing surgery w ith conventional CP during the same time period served as control group. Th ere were no significant differences between both groups with respect to per ioperative myocardial infarction rate, need for positive inotropic medicati on, need for mechanical circulatory support, duration of mechanical ventila tion, duration of intensive care unit stay, time of mobilization, postopera tive renal failure, cardiac arrhythmias, neurological symptoms, infections or in-hospital mortality. ES-patients were less frequently readmitted to th e intensive care unit (ES: 3/150; 2.2% [95% confidence interval: 0-4.2%] vs CP: 13/150; 8.7% [4.2-13.2%]: P = 0.010) and total hospital stay was short er (ES: 12.3 +/- 4.8 days [95% CI: 11.5-13.0] vs CP: 13.5 +/- 3.8 [12.9-14. 1] days; P = 0.0013), thus saving 159 patient days on the normal ward. Proc edural costs were less for the ES-technique (US$ 60 per patient) as compare d to the cardioplegia technique (US$ 120 per patient). These data suggest t hat myocardial protection using the ES-technique does not improve clinical outcome in patients subjected to routine coronary artery surgery, but may s ave costs. (C) 2001 The International Society for Cardiovascular Surgery. P ublished by Elsevier Science Ltd. All rights reserved.