Key result
Selective normothermic myocardial perfusion reduced postoperative norepinephrine needs (P=0.007) with comparable in-hospital mortality (4% vs 11%, P=0.46) compared to standard cardiac arrest.
Why the study?
In contrast to cardioplegic cardiac arrest, some centers use selective normothermic myocardial perfusion during aortic arch repair, but its effects on myocardial injury and inotropic or vasopressor support needed evaluation.
Does selective normothermic myocardial perfusion reduce myocardial injury and the need for vasopressors compared to cardioplegic cardiac arrest in patients undergoing total aortic arch replacement?
Cohort (n=127)
Does selective normothermic myocardial perfusion reduce myocardial injury and the need for vasopressors compared to cardioplegic cardiac arrest in patients undergoing total aortic arch replacement?
p-value: p=0.030
Selective normothermic myocardial perfusion during aortic arch surgery reduces perioperative vasopressor requirements, myocardial injury, and ICU length of stay compared to standard cardioplegic arrest.
May warrant consideration but should not yet change practice; leaves open benefit of selective normothermic perfusion in arch surgery.
BACKGROUND: In contrast to the standard cardioplegic cardiac arrest (CA), some centers prefer the beating-heart technique using selective normothermic myocardial perfusion (SMP) during aortic arch repair. The aim of this study was to evaluate myocardial injury and the need for inotropic and vasopressor support in patients undergoing total aortic arch replacement using SMP or CA during arch repair. METHODS: Total arch replacement was performed in 127 patients (65 years [IQR: 56-73 years] years) between March 2013 and May 2018 via the frozen elephant trunk technique. Of those, 25 patients were operated on with selective myocardial perfusion. Blood samples and catecholamine doses were evaluated. We compared the SMP group's and CA group's outcomes. RESULTS: The two groups' risk factors, underlying aortic pathologies, and surgical details were similar. The SMP group's intraoperative norepinephrine application rates were significantly lower than the CA group's (P=0.030), as were their postoperative norepinephrine application rates (norepinephrine: P=0.007). Postoperative cardiac enzymes tended to be lower in the SMP group; the difference in creatine-kinase MB reached statistical significance after 14 hours (P=0.024). Intensive care unit stay was significantly shorter in the SMP group (P=0.041), and in-hospital mortality was comparable (4% in the SMP and 11% in the CA group; P=0.46). CONCLUSIONS: By applying selective normothermic myocardial perfusion, beating-heart aortic arch surgery has the potential to reduce the need for perioperative inotropes, and it might reduce myocardial injury. This approach is a potentially useful adjunct to our armamentarium, particularly in patients with preexisting myocardial damage or in conjunction of arch repair together with other cardiac procedures.
No takes yet. Share an insight, caveat, or question.
Berger et al. (2020) conducted a cohort in Aortic arch repair (n=127). Selective normothermic myocardial perfusion (SMP) vs. Standard cardioplegic cardiac arrest (CA) was evaluated on Intraoperative and postoperative norepinephrine application rates (p=0.030). Selective normothermic myocardial perfusion reduced postoperative norepinephrine needs (P=0.007) with comparable in-hospital mortality (4% vs 11%, P=0.46) compared to standard cardiac arrest.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: