The effect of using microplegia on perioperative morbidity and mortality in elderly patients undergoing cardiac surgery

• Published in: Interactive cardiovascular and thoracic surgery Vol. 9; no. 1; pp. 56 - 60
• Main Authors: Albacker, Turki B, Chaturvedi, Rakesh, Al Kindi, Adil H, Al-Habib, Hamad, Al-Atassi, Talal, de Varennes, Benoit, Lachapelle, Kevin
• Format: Journal Article
• Language: English
• Published: England Eur Assoc Cardio Surg 01.07.2009
• Subjects: Acute Disease; Age Factors; Aged; Aged, 80 and over; Biomarkers - blood; Blood Transfusion; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Cardiotonic Agents - therapeutic use; Confusion - etiology; Confusion - prevention & control; Female; Heart Arrest, Induced - methods; Heart Diseases - etiology; Heart Diseases - prevention & control; Hematocrit; Hospital Mortality; Humans; Kidney Diseases - etiology; Kidney Diseases - prevention & control; Logistic Models; Male; Patient Selection; Retrospective Studies; Risk Assessment; Risk Factors; Treatment Outcome; Troponin I - blood
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2009.204990

Division of Cardiothoracic Surgery, Department of Surgery, McGill University Health Centre, McGill University, Montreal, Canada *Corresponding author. Royal Victoria Hospital, 687 Pine Avenue West, Suite S8.30, Montreal, QC H3A 1A1, Canada. Tel.: +1(514) 843-1463; fax: +1(514) 843-1602. E-mail address : dr_turki{at}yahoo.com (T.B. Albacker). Old age is a significant risk factor for perioperative morbidity and mortality following cardiac surgery and optimal myocardial protection strategy should be sought in this group of patients. We, therefore, reviewed the data on 295 consecutive patients older than 75 years who underwent any cardiac surgical procedure. Microplegia was used in 144 patients compared to 151 patients who had the standard 4:1 blood cardioplegia. Logistic regression analysis was used for propensity matching to balance the differences between the two groups. The microplegia group included more females and sicker patients as indicated by higher Parsonnet scores. There were differences in the pump time, aortic cross-clamp time, procedure type and surgeons between the two groups. These differences were balanced using the propensity matching. In-hospital mortality, acute renal injury and confusion were higher in the microplegia group (17%, 34%, 35%, respectively) compared to the standard 4:1 cardioplegia group (9%, 23%, 24%, respectively) ( P =0.04, 0.04, 0.04, respectively). These differences were not statistically significant after propensity matching. These results demonstrate that the use of microplegia is safe in patients older than 75 years who are undergoing cardiac surgery and results in similar in-hospital morbidity and mortality to the standard 4:1 blood cardioplegia. Key Words: Microplegia; Cardioplegia; Myocardial protection; Morbidity; Mortality