Michele Di Mauro1, Antonio M Calafiore2, Antonino Di Franco3, Francesco Nicolini4, Francesco Formica4, Roberto Scrofani5, Carlo Antona5, Antonio Messina6, Giovanni Troise6, Giovanni Mariscalco7, Cesare Beghi8, Michele De Bonis9, Cinzia Trumello9, Antonio Miceli10, Mattia Glauber10, Marco Ranucci11, Carlo De Vincentiis11, Mario Gaudino3, Roberto Lorusso12. 1. Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands. Electronic address: mdimauro1973@gmail.com. 2. Department of Cardiac Surgery, Gemelli Molise, Campobasso, Italy. 3. Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, USA. 4. Cardiac Surgery Unit, Ospedale Maggiore, University of Parma, Parma, Italy. 5. Cardiac Surgery Unit, Ospedale Sacco, University of Milan, Milan, Italy. 6. Cardiac Surgery Unit, Poliambulanza Hospital, Fondazione Poliambulanza, Brescia, Italy. 7. Department of Cardiothoracic Surgery, University of Leicester, Leicester, UK. 8. Cardiac Surgery Unit, Ospedale di Circolo, University of Varese, Varese, Italy. 9. Cardiac Surgery Unit, San Raffaele Hospital, University of Milan, Milan, Italy. 10. Cardiac Surgery Unit, S. Ambrogio Hospital, Milan, Italy. 11. Cardiac Surgery and Intensive Care Units, S. Donato Hospital, IRCCS, University of Milan, Milan, Italy. 12. Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Cardiac Surgery Unit, Community Hospital, Brescia, Italy.
Abstract
OBJECTIVE: The aim of this multicenter study was to evaluated whether cold or warm cardioplegia are associated with postoperative atrial fibrillation (POAF) and the prognostic role of the latter on early stroke and neurological mortality. METHOD: This was a retrospective analysis of prospective collected data from 9 cardiac centers in Italy and the United States including patients undergoing surgery between 2010 and 2018. From the 9 institutional databases, 17,231 patients underwent isolated CABG on-pump, using either warm cardioplegia (n = 7730) or cold cardioplegia (n = 9501); among the latter group blood and crystalloid cardioplegia were used in 691 and 8810 patients, respectively. After matching, two pairs of 4162 patients (overall cohort 8324) were analyzed. RESULTS: In matched population, the rate of POAF was 18% (1472 cases), 15% (608) in warm group versus 21% (864) in cold group (p < 0.001). Multivariable analysis confirmed that cold cardioplegia was associated with higher rate of POAF, along with age, hypercholesterolemia, LVEF, reoperation, preoperative IABP, previous stroke, cardiopulmonary and cross-clamp. Moreover, cold cardioplegia as well as POAF increased the rate of postoperative stroke as well as early mortality and neurological mortality Propensity-weighted cohort included 11,830 (70%) patients out of 17,231. After adjustment, both cold blood and cold crystalloid cardioplegia negatively influenced POAF, stroke and neurological mortality. CONCLUSIONS: Warm cardioplegia may reduce the rate of POAF in CABG patients with respect to cold cardioplegia, either blood or crystalloid. This has a prognostic impact on postoperative stroke and neurological mortality.
OBJECTIVE: The aim of this multicenter study was to evaluated whether cold or warm cardioplegia are associated with postoperative atrial fibrillation (POAF) and the prognostic role of the latter on early stroke and neurological mortality. METHOD: This was a retrospective analysis of prospective collected data from 9 cardiac centers in Italy and the United States including patients undergoing surgery between 2010 and 2018. From the 9 institutional databases, 17,231 patients underwent isolated CABG on-pump, using either warm cardioplegia (n = 7730) or cold cardioplegia (n = 9501); among the latter group blood and crystalloid cardioplegia were used in 691 and 8810 patients, respectively. After matching, two pairs of 4162 patients (overall cohort 8324) were analyzed. RESULTS: In matched population, the rate of POAF was 18% (1472 cases), 15% (608) in warm group versus 21% (864) in cold group (p < 0.001). Multivariable analysis confirmed that cold cardioplegia was associated with higher rate of POAF, along with age, hypercholesterolemia, LVEF, reoperation, preoperative IABP, previous stroke, cardiopulmonary and cross-clamp. Moreover, cold cardioplegia as well as POAF increased the rate of postoperative stroke as well as early mortality and neurological mortality Propensity-weighted cohort included 11,830 (70%) patients out of 17,231. After adjustment, both cold blood and cold crystalloid cardioplegia negatively influenced POAF, stroke and neurological mortality. CONCLUSIONS: Warm cardioplegia may reduce the rate of POAF in CABG patients with respect to cold cardioplegia, either blood or crystalloid. This has a prognostic impact on postoperative stroke and neurological mortality.
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