CRYSTALLOID VERSUS BLOOD CARDIOPLEGIA FOR SURGICAL REPAIR OF TYPE A AORTIC DISSECTION: EARLY AND LONG-TERM OUTCOMES

Background: Myocardial injury following surgery repair for type A aortic dissection (TAAD) is one of the most feared perioperative complications. The question of which is the most appropriate cardioplegic solution in this scenario remains debated. We aimed to compare the outcomes of patients who underwent surgery for TAAD according to the cardioplegic strategy. Methods: A retrospective observational study of all consecutive patients (n=393) who underwent surgery for TAAD in our institution between 2003 and 2020 was conducted. The type of cardioplegia (crystalloid histidine-tryptophan-ketoglutarate, “HTK” or blood cardioplegia, “Calafiore”) was at discretion of the surgeon. New onset of postoperative myocardial injury (defined as a 20-fold increase in Troponin T, “cTnT”, from baseline value), and all-cause 30-days and 1-year mortality were the outcomes. Continuous variables were compared using a generalized linear model (lognormal), while categorical variables were compared using two-tailed Chi-squared tests. Results: 251 patients were eligible for the study: 230 received Calafiore, while 21 patients received HTK. Age (59.97 vs 63.14 years; p=0.26) and GERAADA-score (18.12 vs 15.53; p=0.3) were comparable between groups. Postoperative ICU- stay was significantly longer in Calafiore than HTK-group (10.98 days±11.76, vs 6.9 days ±7.99; p=0.041). Mortality differences were not statistically significant (30- days=18.7% vs 9.5%, p=0.385; 1-year=22.6% vs 9.5%, p=0.265). Mean peak postoperative cTnT level was slightly higher in HTK-group, but not statistically different (p=0.87). Incidence of new myocardial injury was 12% (n=28) in Calafiore and 9.5% (n=2) in the HTK group (p=1.0). Conclusions: No differences were found in patients undergoing surgery for TAAD according to cardioplegia solution. HTK cardioplegia may be a safe alternative to blood cardioplegia in these patients.