Myocardial protection in on-pump coronary artery bypass grafting surgery: analysis of the effectiveness of the use of retrograde Celsior (R)

Background: We analyzed the adequacy of the myocardial protection achieved with a single dose of retrograde crystalloid Celsior (R), compared with an accepted standard (microplegia), in on-pump coronary artery bypass grafting surgery (CABG). Methods: This was a retrospective comparative clinical study conducted in a single institution that included all the patients operated on who had elective isolated on-pump CABG, from March 2006 to June 2014. We evaluated maximum postoperative troponin T (TnT) as a marker of myocardial damage, adjusted for possible confounders using propensity score matching. We also analyzed markers of recovery of myocardial function, and the safety of the intravenous use of Celsior (R). Results: During the study period, 261 patients were included, divided in two groups: (a) continuous retrograde blood-based microplegia (114 patients); (b) retrograde single-dose crystalloid Celsior (R) (147 patients). The propensity score adjusted maximum TnT was significantly lower in the Celsior group [average treatment effect = -0.55 ng/dl; 95% confidence interval (CI) -1.10 to -0.1 ng/dl; p = 0.048]. There were no differences in the postoperative use of intra-aortic balloon of counterpulsation or in the requirements of high-dose inotropic medications. In-hospital mortality was equivalent in both study groups (p = 0.73); surgical re-exploration because of bleeding was equivalent (p = 0.37). There were no differences in prolonged mechanical ventilation (p = 0.65) and intensive care unit length of stay (p = 0.87). Conclusion: An isolated single dose of retrograde Celsior (R) may be an effective and safe myocardial protection strategy in on-pump CABG.