Background
Methods
Patient selection
Cardioplegia administration
In the CB group
In the DN group
Statistical analysis
Results
Patient population
UNMATCHED | MATCHED | |||||
---|---|---|---|---|---|---|
DN (n = 131) No.(%) or mean ± SD(MED) | CB (n = 251) No.(%) or mean ± SD(MED) | p value | DN (n = 130) % or mean ± SD | CB (n = 228) % or mean ± SD | SMD | |
Age (years) | 65.8 ± 12.9(68) | 65.8 ± 11.3(67) | 0.99 | 65.8 ± 12.9 | 65.1 ± 9.2 | 0.06248 |
Sex F | 35(26.7) | 73(29.1) | 0.71 | 26.2 | 32.7 | − 0.14296 |
body mass index (kg/m2) | 28.4 ± 5.7 | 29.0 ± 5.8 | 0.35 | 28.4 ± 5.8 | 28.9 ± 4.6 | −0.09552 |
Diabetes | 37(28.2) | 34(33.5) | 0.35 | 28.5 | 28.8 | −0.00664 |
Hypertension | 92(70.2) | 192(76.5) | 0.21 | 70.0 | 72.5 | −0.05526 |
COPD | 21(16.9) | 29(11.6) | 0.26 | 15.4 | 14.8 | 0.01676 |
Stroke | 5(3.8) | 21(8.4) | 0.13 | 3.1 | 3.1 | 0 |
CKD and or dialysis | 9(6.9) | 10(4.0) | 0.22 | 6.2 | 4.5 | 0.07560 |
peripheral vascular disease | 9(6.9) | 31(12.4) | 0.11 | 6.9 | 11.3 | −0.15343 |
Atrial Fibrillation | 38(29) | 43(17.1) | 0.008 | 28.5 | 28.5 | 0 |
NYHA III or IV/IV | 34(26.0) | 65(25.9) | 1.0 | 26.2 | 31.1 | −0.10854 |
Angina CCS >3 | 30(22.9) | 83(33.1) | 0.04 | 23.1 | 20.6 | 0.06053 |
Unstable angina | 10(7.6) | 51(20.3) | 0.0011 | 7.7 | 7.7 | 0 |
Non-elective | 15(11.5) | 58(23.1) | 0.006 | 11.5 | 14.8 | −0.09777 |
Redo | 19(14.5) | 18(7.2) | 0.02 | 13.9 | 12.2 | 0.05048 |
LVEF | 54 ± 11 | 53 ± 11 | 0.62 | 54 ± 11 | 53 ± 9 | 0.09950 |
LVEF <50% | 27(20.9) | 59(23.6) | 0.60 | 21.1 | 23.4 | −0.05532 |
LVEF <35% | 10(7.8) | 20(8.0) | 1.0 | 7.8 | 9.6 | −0.06390 |
Aortic Insufficiency >2/4 | 11(8.5) | 19(7.7) | 0.84 | 8.5 | 7.4 | 0.04067 |
LV Mass Index | 96 ± 29(92) | 96 ± 29(92) | 0.95 | 96 ± 29 | 97 ± 22 | −0.03885 |
Parsonnet Score | 2.9 ± 3.7 | 2.7 ± 3 | 0.59 | 2.7 ± 3.4 | 2.9 ± 2.3 | −0.06890 |
Euroscore II | 5.2 ± 7.1 | 5.3 ± 7.1 | 0.92 | 5.1 ± 7.0 | 5.8 ± 5.5 | −0.11120 |
UNMATCHED | MATCHED | |||||
---|---|---|---|---|---|---|
DN (n = 131) No.(%) | CB (n = 251) No.(%) | p value | DN (n = 130) % | CB (n = 228) % | SMD | |
Isolated CABG | 62(47.3) | 145(57.8) | 0.006 | 47.7 | 58.8 | −0.22386 |
Valvular procedures | 29(22.1) | 27(10.8) | 21.5 | 11.8 | 0.26262 | |
CABG+Valvular procedures | 15(11.5) | 43(17.1) | 11.5 | 14.5 | −0.08929 | |
Others | 25(19.0) | 36(14.3) | 19.2 | 14.9 | 0.11453 |
Operative
UNMATCHED | MATCHED | |||||
---|---|---|---|---|---|---|
DN (n = 131) No.(%) or mean ± SD | CB (n = 251) No.(%) or mean ± SD | p value | DN (n = 130) % or mean ± SD | CB (n = 228) % or mean ± SD | p value | |
Cross-Clamp Time (min) | 81.1 ± 35.6 | 99.4 ± 41.2 | < 0.0001 | 80.8 ± 35.5 | 102.2 ± 31.3 | <0.0001 |
Isolated CABG | 64.6 ± 19.2 | 80.1 ± 24.1 | < 0.0001 | 65.9 ± 4.6 | 85.8 ± 4.6 | < 0.0001 |
Valvular procedures | 76.8 ± 30.3 | 82.0 ± 31.2 | 0.60 | 88.8 ± 17.9 | 110.3 ± 17.9 | 0.02 |
CABG+Valvular procedures | 104.3 ± 31.0 | 134.8 ± 41.4 | 0.05 | 106.7 ± 7.7 | 146.0 ± 7.7 | 0.001 |
Others | 95.3 ± 43.1 | 120.7 ± 45.6 | 0.002 | 113.8 ± 14.3 | 128.9 ± 14.0 | 0.24 |
Isolated valve | 91.9 ± 41.4(85) N = 50/61 | 122.8 ± 43.2(123) N = 79/91 | < 0.0001 | 104.3 ± 9.4 | 127.9 ± 9.2 | 0.0005 |
Multiple valve | 126.7 ± 31.7(120) N = 11/61 | 174.0 ± 43.2(179) N = 12/91 | 0.0074 | 126.7 ± 10.9 | 167.6 ± 11.6 | 0.0179 |
CBP time (min) | 106.3 ± 46.6 | 125.1 ± 49.6 | 0.0004 | 105.9 ± 46.5 | 131.2 ± 38.8 | <0.0001 |
Isolated CABG | 81.6 ± 22.0 | 99.2 ± 28.0 | 0.0001 | 84.9 ± 7.6 | 109.3 ± 7.6 | < 0.0001 |
Valvular procedures | 104.3 ± 34.1 | 113.1 ± 49.3 | 0.51 | 112.4 ± 16.1 | 136.7 ± 16.1 | 0.03 |
CABG+Valvular procedures | 127.8 ± 5.5 | 164.0 ± 47.3 | 0.04 | 132.4 ± 10.0 | 177.3 ± 10.0 | 0.001 |
Others | 127.6 ± 58.3 | 153.8 ± 52.4 | 0.008 | 149.3 ± 11.8 | 166.3 ± 11.8 | 0.31 |
Isolated valve | 124.0 ± 54.1(118) N = 50/61 | 154.1 ± 51.7(152) N = 79/91 | 0.0020 | 137.7 ± 11.2 | 160.3 ± 11.0 | 0.0089 |
Multiple valve | 157.7 ± 43.3(146) N = 11/61 | 210.6 ± 46.4(206) N = 12/91 | 0.0104 | 157.7 ± 12.9 | 205.4 ± 13.7 | 0.0192 |
Length of surgery ‘SkinSkin’ (min) | 204.0 ± 65.5 | 236.4 ± 67.2 | < 0.0001 | 203.1 ± 65.0 | 241.5 ± 54.7 | <0.0001 |
Isolated CABG | 178.5 ± 32.7 | 212.0 ± 46.7 | < 0.0001 | 183.7 ± 8.2 | 224.2 ± 8.2 | < 0.0001 |
Valvular procedures | 198.8 ± 63.3 | 211.4 ± 83.7 | 0.59 | 205.7 ± 25.3 | 229.3 ± 25.3 | 0.19 |
CABG+Valvular procedures | 238.0 ± 94.5 | 270.8 ± 63.0 | 0.25 | 235.3 ± 15.2 | 286.2 ± 15.2 | 0.02 |
Others | 225.2 ± 75.9 | 267.0 ± 73.9 | 0.002 | 251.2 ± 15.2 | 293.4 ± 15.2 | 0.05 |
Isolated valve | 224.3 ± 85.6(215) N = 50/61 | 262.5 ± 76.1(255) N = 79/91 | 0.0092 | 240.0 ± 16.5 | 271.2 ± 16.2 | 0.0200 |
Multiple valve | 246.4 ± 53.1(230) N = 11/61 | 304.9 ± 95.0(324) N = 12/91 | 0.0861 | 246.4 ± 22.3 | 299.9 ± 23.7 | 0.1143 |
Retrograde cardioplegia | 17(13.0) | 76(31.3) | 0.0001 | 13.1 | 38.0 | <0.0001 |
Antegrade cardioplegia | 130(99.2) | 249(99.2) | 1.0 | 99.2 | 98.9 | 0.81 |
Total cardioplegia dose (mL)a | 1331 ± 876 | 3719 ± 1571 | < 0.0001 | 1328 ± 879 | 3773 ± 1226 | <0.0001 |
Minimal temperature on CPB(°C) | 30.4 ± 3.2 | 31.1 ± 3.4 | 0.005 | 30.5 ± 3.2 | 30.8 ± 2.8 | 0.28 |
Glucose peak on CPB (mmol/l) | 8.2 ± 2.3 | 8.8 ± 2.4 | 0.011 | 8.2 ± 2.3 | 9.0 ± 1.8 | 0.001 |
Glucose end CBP (mmol/l) | 8.4 ± 2.6 | 8.2 ± 2.4 | 0.10 | 8.4 ± 2.7 | 8.9 ± 1.9 | 0.06 |
Glucose >10 end of CBP (mmol/l) | 24(20.0) | 62(26.2) | 0.24 | 20.2 | 24.2 | 0.46 |
Transfusion in OR | 48(36.6) | 104(41.4) | 0.38 | 36.2 | 42.7 | 0.27 |
Intraoperative Defibrillation | 21 (16) | 69 (27.5) | 0.02 | 16.9 | 32.4 | 0.01 |
Postoperative
UNMATCHED | MATCHED | |||||
---|---|---|---|---|---|---|
DN (n = 131) No.(%) or mean ± SD(MED) | CB (n = 251) No.(%) or mean ± SD(MED) | p value | DN (n = 130) % or mean ± SD | CB (n = 228) % or mean ± SD | p value | |
ICU stay (days) | 1.9 ± 1.9 | 1.9 ± 2.5 | 0.91 | 1.9 ± 1.8 | 2.0 ± 2.1 | 0.64 |
Length of ventilation (h) | 9.4 ± 27.3(4.4) | 9.1 ± 19.6(4.3) | 0.90 | 9.5 ± 27.4 | 8.9 ± 13.1 | 0.83 |
Intubation >48 h | 4(3.1) | 9(3.6) | 1.0 | 3.1 | 3.6 | 0.83 |
Length of stay (days) | 8.2 ± 5.7 | 8.1 ± 5.3 | 0.82 | 8.0 ± 5.4 | 8.5 ± 4.3 | 0.39 |
Stroke | 3(2.3) | 5(2.0) | 1.0 | 2.3 | 3.7 | 0.52 |
Deep sternal wound infection | 3(2.3) | 2(0.8) | 0.34 | 2.3 | 1.0 | 0.57 |
Dialysis | 4(3.1) | 5(2.0) | 0.50 | 3.1 | 2.8 | 0.89 |
Gastrointestinal complication | 5(3.8) | 13(5.2) | 0.62 | 3.1 | 6.6 | 0.20 |
Hepatic Dysfunction | 3(2.3) | 11(4.4) | 0.40 | 2.3 | 5.8 | 0.17 |
Reoperation for Bleeding | 8(6.1) | 15(6.0) | 1.0 | 6.2 | 4.7 | 0.61 |
In hospital transfusion | 90(68.7) | 173(68.9) | 1.0 | 68.5 | 68.8 | 0.95 |
In hospital Mortality | 3(2.3) | 9(3.6) | 0.76 | 2.3 | 5.1 | 0.24 |
Myocardial protection
UNMATCHED | MATCHED | |||||
---|---|---|---|---|---|---|
DN (n = 131) No.(%) or mean ± SD | CB (n = 251) No.(%) or mean ± SD | p value | DN (n = 130) % or mean ± SD | CB (n = 228) % or mean ± SD | p value | |
LVEF (%) | 52 ± 11 | 50 ± 12 | 0.22 | 52 ± 11 | 51 ± 10 | 0.37 |
Needing Inotropes for low cardiac outflow | 11(8.4) | 17(6.8) | 0.54 | 8.5 | 9.2 | 0.84 |
Postop Atrial Flutter | 34(26.0) | 42(16.7) | 0.04 | 25.4 | 19.0 | 0.43 |
Atrial Fibrillation de Novo | 35(26.7) | 74(29.5) | 0.63 | 26.9 | 26.5 | 0.93 |
Postop VT/VF | 8(6.1) | 7(2.8) | 0.16 | 5.4 | 4.1 | 0.63 |
Conduction Abnormalities | 6(4.6) | 13(5.2) | 1.0 | 4.6 | 4.6 | 1.0 |
Pacemaker | 5(3.8) | 9(3.6) | 1.0 | 3.9 | 4.5 | 0.80 |
UNMATCHED | MATCHED | |||||
---|---|---|---|---|---|---|
T Troponin (ng/L) | DN (n = 131) mean ± SD | CB (n = 251) mean ± SD | p value | DN (n = 130) mean ± SD | CB (n = 228) mean ± SD | p value |
Day 0 | 872 ± 1617 | 906 ± 1118 | 0.81 | 871 ± 1623 | 958 ± 854 | 0.50 |
Day 1 | 860 ± 1137 | 933 ± 1016 | 0.52 | 853 ± 1139 | 993 ± 823 | 0.21 |
Day 2 | 677 ± 1465 | 613 ± 686 | 0.57 | 671 ± 1469 | 636 ± 519 | 0.77 |
Day 4 | 450 ± 545 | 461 ± 483 | 0.84 | 442 ± 540 | 463 ± 317 | 0.67 |
Maximum peak | 1186 ± 2116 | 1119 ± 1243 | 0.70 | 1182 ± 2124 | 1171 ± 957 | 0.95 |