Celsior Versus Microplegia: Analysis of Myocardial Protection in Elective Aortic Valve Replacement

• Published in: The Annals of thoracic surgery Vol. 103; no. 1; pp. 25 - 31
• Main Authors: López-Menéndez, Jose, MD, PhD, Miguelena, Javier, MD, Morales, Carlos, MD, PhD, Díaz, Carmen L., PhD, Callejo, Francisco, MD, Llosa, Juan Carlos, MD, PhD, Silva, Jacobo, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-01-2017
• Subjects: Aged; Aortic Valve - surgery; Cardioplegic Solutions; Cardiothoracic Surgery; Disaccharides - pharmacology; Elective Surgical Procedures - methods; Electrolytes - pharmacology; Female; Follow-Up Studies; Glutamates - pharmacology; Glutathione - pharmacology; Heart Arrest, Induced - methods; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - methods; Histidine - pharmacology; Humans; Male; Mannitol - pharmacology; Retrospective Studies; Surgery
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2016.09.049

Background Previous studies have analyzed the efficacy of crystalloid cardioplegic solutions, but the use of Celsior (Genzyme Corp, Boston, MA) as a crystalloid cardioplegic solution has not been evaluated. Methods In this observational retrospective study, Celsior crystalloid solution was compared with an all-blood continuous myocardial protection (microplegia). The study included all patients who underwent elective aortic valve replacement operations in whom the myocardial protection was Celsior or microplegia. The primary end points were surrogates of myocardial protection and death at 30 days. The secondary end point was the safety analysis of the use of Celsior. Results The study included 631 patients, divided in two groups: 219 (34.7%) with microplegia and 412 (65.3%) with Celsior. Troponin T release accurately predicted postoperative death (area under the receiver operating characteristic curve = 0.85). Troponin T increased with the duration of clamp time, and the adjusted time-related increase was lower in the Celsior group. There were no statistically significant differences in the postoperative use of inotropic medication or intraaortic balloon pump. Adjusted postoperative death was lower in Celsior group (odds ratio, 0.33; 95% confidence interval, 0.15 to 0.76). There were no allergic reactions attributed to Celsior and no unexpected toxicity with the use of Celsior (coagulopathy, renal dysfunction, liver dysfunction, or encephalopathy). Conclusions Isolated crystalloid Celsior may be an optimal and safe myocardial protection strategy in aortic valve replacement operations.