# Comparison of clinical outcomes of open and closed cardioplegia sets used during cardiopulmonary bypass

## TL;DR

This study compares open and closed cardioplegia systems during heart surgery, finding that closed systems may reduce inflammation and liver stress but delay recovery.

## Contribution

The study provides new clinical evidence on the inflammatory and biochemical outcomes of open versus closed cardioplegia systems during cardiac surgery.

## Key findings

- Closed cardioplegia systems showed lower postoperative white blood cell and C-reactive protein levels, indicating reduced inflammation.
- Closed systems also had lower aspartate aminotransferase and gamma-glutamyl transferase levels, suggesting less hepatic stress.
- Despite better biochemical outcomes, closed systems were associated with longer extubation time and reduced urine output.

## Abstract

The aim of this retrospective study was to evaluate early clinical outcomes and inflammatory responses associated with the use of open and closed cardioplegia sets in patients undergoing cardiac surgery with cardiopulmonary bypass.

A total of 123 adult patients who underwent elective cardiac surgery with cardiopulmonary bypass between 2023 and 2024 were included. Patients were divided into two groups based on the cardioplegia system used: Group 1 (open system, n=63) and Group 2 (closed system, n=60). Demographic features, intraoperative variables, and preoperative and postoperative biochemical parameters (white blood cell count, C-reactive protein, glucose, and liver and renal function tests) were analyzed. Statistical significance was set at p<0.05.

Preoperative characteristics and most laboratory parameters were comparable between the groups (p>0.05). Postoperatively, white blood cell (12.64±3.47 vs. 8.43±4.43, p=0.031), C-reactive protein (28.00±32.28 vs. 8.42±6.37, p<0.0001), glucose (150.66±82.40 vs. 174.19±51.89, p=0.043), aspartate aminotransferase (p=0.001), and gamma-glutamyl transferase (p<0.0001) levels were significantly lower in the closed system group. Extubation time was longer in the closed group (8.56±3.18 vs. 5.15±0.66 h, p<0.0001), while urine output was significantly lower (554.16±401.50 vs. 916.34±709.58 mL, p=0.001). No differences were observed in hospital or intensive care unit stay.

Closed cardioplegia systems may offer better control of inflammatory and hepatic responses during cardiac surgery with cardiopulmonary bypass. Despite favorable biochemical outcomes, the longer extubation time and reduced urine output observed in the closed system group warrant further investigation. Future prospective randomized studies are required to validate these findings and assess long-term clinical outcomes such as morbidity and mortality.