Patient Outcomes after Introduction of Novel Myocardial Protection Protocol for Prolonged Aortic Cross-Clamping.

Purpose: Cardioplegia directly affects patient outcomes after cardiac surgery with prolonged aortic cross-clamping. Our hospital revised its myocardial protection protocol in April 2021 and compared the clinical outcomes of patients with prolonged aortic cross-clamping before versus after the revision.

Methods: This study included 36 patients who underwent cardiac surgery via a median sternotomy and prolonged aortic cross-clamping for >4 h at our hospital from 2018 to 2024. Patients treated between 2018 and March 2021 (before the protocol revision) were designated as Group 1, while those treated from April 2021 to 2024 (after the revision) were designated as Group 2.

Results: Groups 1 and 2 comprised 17 and 19 patients, respectively. The mean creatine kinase level immediately postoperative was significantly lower in Group 2 versus Group 1 (P = 0.018). The mean hospital stay was also significantly shorter in Group 2 versus Group 1 (P = 0.017). Regarding new postoperative right-ventricular dysfunction, there were 3 cases (15.8%) in Group 2 versus 5 cases (29.4%) in Group 1, but the difference was not statistically significant.

Conclusion: These findings suggest that our hospital's revised myocardial protection protocol, which requires no alteration of the solution itself, achieves safe and favorable surgical results, even in cardiac surgeries requiring prolonged aortic cross-clamping.