Custodiol versus cold Calafiore for elective cardiac arrest in isolated aortic valve replacement: a propensity-matched analysis of 7263 patients.
OBJECTIVE
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.
Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
Alexandro
A
Hoyer
Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
Sven
S
Lehmann
Clinical Trial Center, University of Leipzig, Leipzig, Germany.
Meinhard
M
Mende
Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
Thilo
T
Noack
Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
Philipp
P
Kiefer
Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
Martin
M
Misfeld
Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
Farhad
F
Bakhtiary
Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany.
Friedrich Wilhelm
FW
Mohr
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D002314:Cardioplegic Solutions
Aortic valve surgery; Cardioplegia; Myocardial protection; Operative mortality; Propensity score