‘When more is less’. Reviewing the safety and cost of cardioplegia delivery

Abstract

There have been several new cardioplegia delivery systems that have been developed by various manufacturers in the last few years. In this evaluation, the safety and costs associated with the present 4:1 roller pump cardioplegia delivery were compared to the Medtronic Cardioplegia Safety System™ (CSS™). One hundred and five patients participated in a randomized, prospective evaluation. The current cardioplegia delivery system consists of using the 4:1-B MYOtherm XP™ disposable by Avecor Cardiovascular and a Sarns™ MDX 7000 roller pump. The Medtronic Cardiotherm™ disposable cardioplegia unit was used in conjunction with the CSS™. The current delivery system will be referred to as group A and the system under evaluation will be referred to as group B. Two varying techniques are employed for cardioplegia delivery and are based on surgeon preference. An equal distribution of techniques was seen in both groups. Results indicated that in group A, a hemoconcentrator was required 60.3% of the time, whereas in group B, a hemoconcentrator was added only 25.0% of the time. The average total cardioplegia delivered in group A was 6588 cm³ compared to 7123 cm³ in group B. Although this is insignificant, the greatest difference was seen in the amount of crystalloid given. In group A, the crystalloid portion was 1317 cm³ compared to only 877 cm³ in group B. There was equal weight gain and hemodilution postop in both groups. Twenty-five incidences of pressurization of the cardioplegia system occurred during the evaluation, with equal distribution in both groups. This evaluation showed that the CSS™ responded without fail to all pressurization incidences. The Medtronic CSS™ has incorporated several safety systems for pressurization and air embolism protection, which are programmable and preset by the perfusionist. The Avecor disposable has a pressurization valve that activates at a pressure greater than 600 mmHg in the cardioplegia circuit. The Sarns™ MDX 7000 does not incorporate any safety shutoffs. Cost savings were achieved in two areas: hemoconcentrator use and volume of cardioplegia solution required. There was a reduction of 35% in the use of a hemoconcentrator in group B, with more total cardioplegia delivered. The cardioplegia patient cost savings in group B totaled $265.95 per case in the plain cardioplegia group and $315.95 with the amino acid cardioplegia group. The new technology incorporated into the Medtronic CSS™ demonstrated that it could provide more safety with less cost than the current cardioplegia pump system.