Background: Combined valvular and coronary artery bypass grafting (CAB G) surgery requires a long period of cardioplegic arrest (CA) that predisposes the heart to ischaemiareperfusion injury, low cardiac output syndrome, reperfusion dysrhythmias, inhospital mortality and increased costs. Procedures that can reduce the duration of CA would be expected to reduce intraoperative and postoperative complications. Mehods: Adults undergoing combined valvular and CABG surgery were randomized to either coronary surgery performed on the beating heart with cardiopulmonary bypass (CPB) support followed by CA for the valvular procedure (hybrid group) or surgery with both procedures carried out under CA (conventional group). The primary outcome was a composite of in-hospital death, postoperative myocardial infarction, cardiac dysrhythmias, requirements for cardiac pacing for more than 12 hours and/or inotropic support for more than 12 hours postoperativeiy. Results: One hundred and sixty patients (80 hybrid, 80 conventional) were randomized between March 2008 and July 2012. Mean age was 66.5 years and 74% were male. Valvular procedures included aortic (61.8%) and mitral (33.1%) alone or in combination (5.l %). The primary outcome occurred in 64/80 of the conventional group patients and 67/80 of the hybrid group patients (odds ratio 1.24, 95% Cl 0.54 to 2.86, p=0.61). The CA time was, on average, 16% shorter in the hybrid group (median 98 minutes vs. 89 minutes, geometric mean ration (GMR) 0.84, 95% Cl 0.77 to 0.93 , p=0.0004), but the overall duration of CPB was on average 7% longer in the hybrid group (GMR 1.07, 95% Cl 0.98 to 1.16, p=0.12). Cardiac troponin T plasma concentrations and levels of metabolites measured in heart biopsies were similar between the two treatment groups. Conclusion: The hybrid technique reduced the CA time, but this did not result in a significant reduction in the frequency of the primary outcome. In this trial the clinical outcomes and the extent of the myocardial injury were similar between the two surgical methods.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:681543 |
| Date | January 2014 |
| Creators | Capoun, Radek |
| Publisher | University of Bristol |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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