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

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.