Custodiol versus cold Calafiore for elective cardiac arrest in isolated aortic valve replacement: a propensity-matched analysis of 7263 patients

Abstract

Objectives: This study was designed to assess the impact of crystalloid cardioplegia (CCP) and blood cardioplegia (BCP) on short- and long-term outcome after isolated aortic valve replacement (AVR).

Methods: A total of 7263 patients undergoing AVR at our institution between November 1994 and June 2015 were identified. CCP (Custodiol ® ) was used in 83% ( n = 5998) and intermittent cold BCP in 1007 patients (14%). For 4790 patients, propensity scores were calculated from baseline data, risk factors, comorbidities and characteristics of the disease, resulting in 825 pairs. The primary outcome was operative mortality (OM).

Results: There was no significant difference in OM between CCP and BCP cohorts [33 of 825 (4.0%) vs 35 of 825 (4.2%), P = 0.90]. The incidence of postoperative complications was comparable between both groups. Long-term survival was also not different between CCP and BCP (log-rank test: P = 0.9). Multiple Cox regression analysis demonstrated that mortality was significantly affected by renal function ( P < 0.001), logistic EuroSCORE ( P < 0.001), male sex ( P = 0.005) and diabetes ( P = 0.037). Patients with reduced left ventricular ejection fraction ≤30% showed improved survival when receiving BCP intraoperatively [odds ratio: 2.28 (1.12-4.63); P = 0.03].

Conclusions: CCP and BCP provide equivalent outcome after isolated AVR. However, BCP seems to be beneficial for patients with reduced left ventricular ejection fraction.

Keywords: Aortic valve surgery; Cardioplegia; Myocardial protection; Operative mortality; Propensity score.