Tepid antegrade intermittent blood cardioplegia as an alternative for intermittent crossclamping with Lidoflazine

Background: Blood cardioplegia is a technique with many variations in its use. Intermittent cross clamping with Lidoflazine has proven to deliver good cardioprotection in our center. Question: Is tepid (32 ̊C) antegrade intermittent blood cardioplegia an efficient, safe and easy-to-use alternative to intermittent crossclamping with Lidoflazine in elective isolated CABG in low-risk patients? Primary outcomes are heart enzymes (cTnI, CK-MB). Secondary outcomes are operation times, length of hospital stay, major complications and in-hospital mortality. Methods: From January 2012 until November 2012, 40 patients with LVEF ≥50%, EuroSCORE II <3.5% and no severe systemic disease underwent elective CABG and were consecutively randomized to intermittent cross-clamping (ICC; n = 20) or blood cardioplegia (BCP; n = 20). All were operated on by the same surgeon. Results: There were no significant differences in age (BCP 65.34 ± 9.76; ICC 65.25 ± 8.42) and EuroSCORE II (BCP 1.25 ± 0.72; ICC 1.04 ± 0.71). There was a significant difference in cross clamp time (BCP 61.10 ± 23.07; ICC 41.30 ± 13.10). No significant differences in ECC-time (BCP 95.85 ± 27.04; ICC 113.80 ± 34.47) and number of distal anastomoses (BCP 2.70 ± 0.73; ICC 2.90 ± 0.72) were found. Values of cTnI 1-day postoperative (BCP 1.50 ± 0.76; ICC 4.50 ± 3.90), maximum cTnI (BCP 2.85 ± 1.73; ICC 6.40 ± 4.30) and maximum CK-MB (BCP 21.10 ± 22.30; ICC 31.35 ± 24.39) differed significantly. No significant differences in postoperative parameters were found: length of hospital stay (BCP 7.95 ± 1.40; ICC 8.25 ± 1.71), atrial fibrillation (BCP 0.20 ± 0.41; ICC 0.45 ± 0.51), major complications (BCP 0.35 ± 0.49; ICC 0.30 ± 0.47). There was no in-hospital mortality. Conclusion: Primary outcomes defined by the cardiac enzymes (cTnI, CK-MB) favour the use of tepid antegrade intermittent blood cardioplegia in low-risk patients undergoing elective CABG-operations. Regarding secondary outcomes, ICC showed shorter cross clamp times.