ARIAM, 25 años salvando corazones / ARIAM, 25 years saving hearts

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Índice de cardioplejía infundida: una nueva herramienta en la protección miocárdica. Un estudio de cohortes / Infused cardioplegia index: A new tool to improve myocardial protection. A cohort study

Objetivo: La cardioprotección es esencial en la revascularización coronaria quirúrgica. En este estudio exploramos la relación existente entre el tiempo que una masa miocárdica permanece en situación de isquemia y la dosis de cardioplejía utilizada para su preservación, reflejada a través del índice de cardioplejía infundida, con el desarrollo de bajo gasto cardiaco postoperatorio. Diseño: Se incluyeron todos los pacientes sometidos a revascularización coronaria quirúrgica entre enero de 2013 y diciembre de 2015. El síndrome de bajo gasto cardiaco postoperatorio se definió siguiendo los criterios del documento de consenso de la SEMYCIUC. Se analizaron los factores perioperatorios asociados al síndrome de bajo gasto cardiaco y, mediante la curva ROC, se determinó el punto de corte del índice de cardioplejía infundida para predecir la ausencia del mismo. Resultados: De los 360 pacientes incluidos, 116 (32%) presentaron bajo gasto postoperatorio. Los factores de riesgo independientes fueron: clasificación funcional de la New York Heart Association (OR 1,8 [IC 95%=1,18-2,55]), la fracción de eyección del ventrículo izquierdo (OR 0,95 [IC 95%=0,93-0,98]), el empleo de cardioplejía retrógrada (OR 1,2 [IC 95%=1,03-1,50]) y el índice de cardioplejía infundida (OR 0,99 [IC 95%=0,991-0,996]), que mostró un área bajo la curva ROC de 0,77 (0,70-0,83; p<0,001) para la ausencia de síndrome de bajo gasto cardiaco postoperatorio, usando como punto de corte óptimo 23,6ml·min-1(100g/m2 de VI)-1. Conclusiones: El índice de cardioplejía infundido es inversamente proporcional a los requerimientos postoperatorios de inotropos, pudiendo constituir una estrategia para optimizar la cardioprotección. El volumen total de cardioplejía intermitente debería calcularse, de forma individualizada, en base al índice de masa del ventrículo izquierdo y el tiempo de isquemia

Background: Strategies for cardio-protection are essential in coronary artery bypass graft surgery. The authors explored the relationship between cardioplegia volume, left ventricular mass index and ischemia time by means of the infused cardioplegia index and its relationship with post-operative low cardiac output syndrome. Design: All patients undergoing coronary artery bypass graft surgery between January 2013 and December 2015 were included. Low cardiac output syndrome was defined according to criteria of the SEMICYUC's consensus document. The perioperative factors associated with low cardiac output syndrome were estimated, and using a ROC curve, the optimum cut-off point for the infused cardioplegia index to predict the absence of low cardiac output syndrome was calculated. Results: Of 360 patients included, 116 (32%) developed low cardiac output syndrome. The independent risk predictors were: New York Heart Association Functional Classification (OR 1.8 [95% CI=1.18-2.55]), left ventricle ejection fraction (OR 0.95 (95% CI=0.93-0.98]), ICI (OR 0.99 [95% CI=0.991-0.996]) and retrograde cardioplegia (OR 1.2 [95% CI=1.03-1.50]). The infused cardioplegia index showed an area under the ROC curve of 0.77 (0.70-0.83; P<.001) for the absence of postoperative low cardiac output syndrome using the optimum cut-off point of 23.6ml·min-1(100g/m2 of LV)-1. Conclusions: The infused cardioplegia index presents an inverse relationship with the development of post-operative low cardiac output syndrome. This index could form part of new strategies aimed at optimising cardio-protection. The total volume of intermittent cardioplegia, especially that of maintenance, should probably be individualised, adjusting for ischemia time and left ventricle mass index

Infused cardioplegia index: A new tool to improve myocardial protection. A cohort study. / Índice de cardioplejía infundida: una nueva herramienta en la protección miocárdica. Un estudio de cohortes.

BACKGROUND: Strategies for cardio-protection are essential in coronary artery bypass graft surgery. The authors explored the relationship between cardioplegia volume, left ventricular mass index and ischemia time by means of the infused cardioplegia index and its relationship with post-operative low cardiac output syndrome. DESIGN: All patients undergoing coronary artery bypass graft surgery between January 2013 and December 2015 were included. Low cardiac output syndrome was defined according to criteria of the SEMICYUC's consensus document. The perioperative factors associated with low cardiac output syndrome were estimated, and using a ROC curve, the optimum cut-off point for the infused cardioplegia index to predict the absence of low cardiac output syndrome was calculated. RESULTS: Of 360 patients included, 116 (32%) developed low cardiac output syndrome. The independent risk predictors were: New York Heart Association Functional Classification (OR 1.8 [95% CI=1.18-2.55]), left ventricle ejection fraction (OR 0.95 (95% CI=0.93-0.98]), ICI (OR 0.99 [95% CI=0.991-0.996]) and retrograde cardioplegia (OR 1.2 [95% CI=1.03-1.50]). The infused cardioplegia index showed an area under the ROC curve of 0.77 (0.70-0.83; P<.001) for the absence of postoperative low cardiac output syndrome using the optimum cut-off point of 23.6ml·min-1(100g/m2 of LV)-1. CONCLUSIONS: The infused cardioplegia index presents an inverse relationship with the development of post-operative low cardiac output syndrome. This index could form part of new strategies aimed at optimising cardio-protection. The total volume of intermittent cardioplegia, especially that of maintenance, should probably be individualised, adjusting for ischemia time and left ventricle mass index.