Maloney J V, Cooper N, Mulder D G, Buckberg G D
Circulation. 1975 Aug;52(2 Suppl):I3-8.
Our experimental studies since 1972 show that the heart is preserved best during cardiopulmonary bypass when it is in the beating, nonworking state. Results after mitral valve replacement (MVR) from 1968 to 1974 using various techniques of cardiac preservation were compared. In group I were 47 patients (1968 to 1972) in which either profound, topical hypothermia with prolonged ischemic arrest (19) or ventricular fibrillation with continuous coronary perfusion (28) was used. In group II there were 22 patients (1972 to 1974) in whom the heart was in a beating, nonworking state between brief periods of ischemic arrest. In group I 55% (25/47) required inotropic support postoperatively, and 17% (8/47) died. In group II 5% (1/22) required inotropic support postoperatively, and this patient died (5% mortality). Extended periods of ischemic arrest were necessary because of intraoperative complications in this patient. These data show that depressed postoperative myocardial performance occurs rarely when the heart is preserved in the beating, nonworking state during MVR and ventricular fibrillation and prolonged topical hypothermic anoxic arrest are avoided.
我们自1972年以来的实验研究表明，在体外循环期间，心脏处于跳动的无工作状态时保存得最好。比较了1968年至1974年采用各种心脏保存技术进行二尖瓣置换术（MVR）后的结果。第一组有47例患者（1968年至1972年），其中19例采用深度局部低温并延长缺血停搏，28例采用心室颤动并持续冠状动脉灌注。第二组有22例患者（1972年至1974年），其心脏在短暂缺血停搏期间处于跳动的无工作状态。第一组中55%（25/47）的患者术后需要正性肌力支持，17%（8/47）死亡。第二组中5%（1/22）的患者术后需要正性肌力支持，该患者死亡（死亡率5%）。由于该患者术中出现并发症，需要延长缺血停搏时间。这些数据表明，在二尖瓣置换术期间，当心脏处于跳动的无工作状态时，术后心肌功能低下很少发生，并且避免了心室颤动和延长局部低温缺氧停搏。
