Page 57 - ANZCP Gazette May 2023

3SCTS ABSTRACTS – CAIRNS 2022
HIGH SENSITIVITY TROPONIN-T PROFILE POST MULTI-DOSE DEL NIDO CAR DIOPLEGIA
Abbey Knox, Damian Gimpel, Jordan Ross, Richard Newland, Gareth Crouch, Gregory Rice, Robert Baker AND Jayme Bennetts
Cardiothoracic Surgery, Flinders Medical Centre, SA
PURPOSE: There is no clear published regimen for multi-dose del Nido cardioplegia in cardiac surgery cases with extended aortic cross clamp times. The aim of this study was to examine the post-operative troponin profile between del Nido and hyperkalaemic cardioplegia for cases with aortic cross clamp times greater than 90 minutes.
METHODOLOGY: Single centre retrospective study of adult patients who underwent cardiac surgery between April 2016 and December 2021 and required multiple doses of cardioplegia, with an aortic cross clamp time of longer than 90 minutes. A propensity matched (1:1) analysis was used to compare patients who received del Nido cardioplegia (n=145) to those who received hyperkalaemic blood cardioplegia (n=145). Primary outcome was post-operative troponin profile from 6 to 72 hours. Secondary outcomes were in-hospital and 30- day mortality, and major adverse cardiac events.
RESULTS: There was no significant difference in the peak or median post-operative troponin profile at 6, 12 and 72 hours between cohorts. Post-operative outcomes and mortality were similar. Patients in the del Nido cardioplegia cohort received less cardioplegia volume (p<0.001) and were more likely to return to a spontaneous rhythm (p<0.001).
CONCLUSION: A second dose of del Nido cardioplegia at 90 minutes demonstrated no difference in post-operative troponin profile compared to hyperkalaemia blood cardioplegia. Further studies are required to validate the optimum regime for multi-dose del Nido cardioplegia in cases with extended aortic cross clamp time.
A SINGLE CENTRE CARDIOPLEGIA AUDIT USING THE TROPONIN-T BIOMARKER
Neil Curran, Joy Singh AND Peter Grant
Prince of Wales Hospital Sydney NSW Australia, NSW
PURPOSE: The cardiothoracic surgery and clinical perfusion departments at our institution recently altered their cardioplegia system and strategy. In an ongoing commitment to best practice, the department has audited the outcomes of this practice change.
METHODOLOGY: A retrospective, observational study of cardiac surgery patients was conducted from March 2017 to November 2021. Inclusion and exclusion criteria were selected. Postoperative care in the cardiothoracic ICU was standardised. Perioperative data collection was complete. The highly sensitive biomarker cardiac Troponin-T was measured postoperatively and analysed by multivariate analysis.
RESULTS: A total of 470 patients were included in this study and were well matched into cohorts for each protocol. Mean peak troponin levels for the new strategy were reduced for CABGx1 and CABGx2 groups but not for CABGx3, nor for valve surgery cases. Rates of new post-operative atrial fibrillation were reduced with the new strategy.
CONCLUSION: The data suggests that the new cardioplegia strategy is at least as good as the previous strategy and is in keeping with acceptable international standards. The observed troponin findings are consistent with published data showing a directly proportional relationship with the number of distal aortocoronary anastomoses and postoperative troponin. Notably, the decrease in troponin for the new strategy is only present when cross-clamp times are under 60 minutes. Since these were relatively uncomplicated patients with isolated cardiac procedures, , extrapolation of results beyond the study parameters is limited. We continue our commitment to clinical audit and seek to continuously improve the care we provide to our cardiac surgery patients.
FEASIBILITY OF DAH30 IN A SINGLE AUSTRALIAN CARDIAC CENTRE
Rona Steel, Jeremy Field AND Michelle Byrnes
Westmead Hospital, NSW
Post-operative days alive and at home within 30 days (DAH30) is a well described surrogate, quantitative measure of the quality of care received in hospital and the patient’s recovery. Time at home is an important patient-centred outcome that is highly valued by patients, clinicians, administrators and the community. DAH30 is a more sensitive measure of quality than the traditional postoperative length of stay, which doesn’t detect early death or readmissions. DAH30 may also prove a useful benchmark between surgical centres and patient populations (1).
The aim of this project was to determine the feasibility MAY 2023 | www.anzcp.org 54