Reply to Bozok et al.

Abstract

We thank Bozok and colleagues for their interest in our article [1, 2]. We would like to remind the readership that our report was a prospective randomized study of 345 consecutive AVR operations, comparing cold crystalloid cardioplegia with cold blood cardioplegia. The demographic data were similar in both groups, including the distribution of valve sizes. The main endpoint was hospital death and the secondary endpoints were low output syndrome, myocardial infarction, arrhythmias, duration of ventilatory support, stroke or minor neurological dysfunction, renal function, infections, blood transfusions and physical rehabilitation. No statistically significant differences were seen between the groups, also when comparing the patients with the longest ischaemic times. We do not think that more sophisticated tests of preoperative or postoperative myocardial dysfunction would have changed our conclusions. The absence of any differences in clinical variables or complications clearly indicated that none of the two cardioplegia techniques could be regarded as superior. In our material, there was a slight difference in the frequency of CABG as for the number of distal anastomoses (3.0 anastomoses versus 2.5 (P = 0.02) in favour of the crystalloid group). However, cardiopulmonary bypass times and crossclamp times turned out to be similar in both groups, and these intra-operative variables appear more relevant when comparing the effects of different techniques for myocardial protection.