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J Thorac Cardiovasc Surg 2003;125:121-125
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Continuous retrograde blood cardioplegia is associated with lower hospital mortality after heart valve surgery

Willem J. Flameng, MD, PhDa, Paul Herijgers, MD, PhDa, Sarah Dewilde, MScb, Emmanuel Lesaffre, PhDb

From Cardiac Surgerya and Biostatistical Centre,b Katholieke Universiteit Leuven, Belgium.

Received for publication March 22, 2002. Revisions requested June 13, 2002; revisions received June 21, 2002. Accepted for publication July 15, 2002. Address for reprints: W. Flameng, MD, PhD, Department of Cardiac Surgery, U.Z. Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium (E-mail: Willem.Flameng{at}med.kuleuven.ac.be).

Objective: Myocardial preservation studies comparing blood and crystalloid cardioplegia techniques were almost exclusively performed on patients undergoing coronary bypass, and they were unable to show a difference in hospital mortality. We investigated possible factors, including cardioplegia techniques, influencing hospital mortality in patients undergoing cardiac valve surgery.
Methods: We evaluated hospital mortality in 1098 consecutive patients undergoing cardiac valve surgery by using a multivariate logistic regression with propensity score balancing of the groups. In 25% of the patients, multiple valve or Bentall procedures were performed, and in 46% of all patients, coronary bypass grafting was associated with valve surgery. A first cohort of 504 consecutive patients were operated on by using single-shot antegrade cold crystalloid cardioplegia, and a second cohort of 594 patients were operated on by using continuous retrograde cold blood cardioplegia.
Results: After correction for patient-related and operative risk factors, lower hospital mortality was found in patients who received retrograde blood cardioplegia (P = .020). The odds ratio of in-hospital death when using blood cardioplegia was 0.44 (95% confidence interval, 0.22-0.88). Further predictors of hospital mortality were age, advanced New York Heart Association functional class, cardiopulmonary bypass time, reoperation, active endocarditis, and renal failure.
Conclusions: This study shows that continuous retrograde blood cardioplegia is associated with lower hospital mortality in heart valve operations.






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