Selimoglu Ozer, Basaran Murat, Ozcan Hamiyet, Kafali Eylul, Ugurlucan Murat, Ozcelebi Cuneyt, Ogus Noyan Temucin
Cardiovascular Surgery Clinic, Goztepe Safak Hospital, Istanbul, Turkey.
Heart Surg Forum. 2007;10(4):E309-14. doi: 10.1532/HSF98.20071052.
The prevention of perioperative ischemia-reperfusion injury is of critical importance, and this issue becomes more important in patients undergoing an early emergent revascularization procedure after an acute myocardial infarction. In this study, we sought to test the hypothesis that our simplified pressure-controlled initial reperfusion technique would be protective against ischemia-reperfusion injury in this subgroup of patients.
The data of 20 patients (group I) who underwent an emergent coronary artery bypass grafting procedure were analyzed and compared with the results of 37 patients (group II) underwent an innovative reperfusion technique. In group I patients, the operation was carried out using standard techniques. In group II, after the completion of all anastomoses, reperfusion was initiated before rewarming with a pressure of 20 to 25 mmHg and continued for a 2-minute period. Systemic blood pressure was then gradually increased to 40 mmHg and the aortic root was perfused at this pressure for another 2-minute period. Following the completion of the second low-pressure reperfusion period, cardiopulmonary bypass flow was regulated to preoperatively calculated values until systemic temperature reached 37 degrees C.
Both groups showed significant differences in terms of cardiac output, arrhythmia rates, and biochemical parameters. Spontaneous sinus rhythm recurred more frequently in group II (P < .01, 86% versus 45%). Atrial fibrillation attacks were observed in 5 and 3 patients in groups I and II, respectively. All patients were medically converted to sinus rhythm with amiadarone and/or beta-blockers. Persistent electrocardiographic changes indicating postoperative myocardial infarction occurred in 5 patients in group I and in 1 patient in group II (P = .003). Postoperative enzyme levels were found to be lower in group II patients and the differences became statistically significant at the end of 24 hours.
These results indicate that our controlled initial reperfusion technique is effective in the prevention of ischemia-reperfusion injury. We advocate the use of this innovative technique as an alternative to complex controlled aortic root reperfusion with the guidance of the early promising results of this study.
围手术期缺血再灌注损伤的预防至关重要，在急性心肌梗死后接受早期紧急血运重建手术的患者中，这个问题变得更加重要。在本研究中，我们试图验证以下假设：我们简化的压力控制初始再灌注技术对该亚组患者的缺血再灌注损伤具有保护作用。
分析了20例行紧急冠状动脉旁路移植术患者（I组）的数据，并与37例行创新再灌注技术患者（II组）的结果进行比较。I组患者采用标准技术进行手术。在II组中，完成所有吻合后，在复温前以20至25 mmHg的压力开始再灌注，并持续2分钟。然后将全身血压逐渐升至40 mmHg，并在此压力下对主动脉根部进行另外2分钟的灌注。在第二个低压再灌注期结束后，将体外循环流量调节至术前计算的值，直到体温达到37℃。
两组在心输出量、心律失常发生率和生化参数方面均存在显著差异。II组自发窦性心律恢复更为频繁（P < 0.01，86%对45%）。I组和II组分别有5例和3例患者发生房颤发作。所有患者均通过胺碘酮和/或β受体阻滞剂药物转复为窦性心律。I组有5例患者和II组有1例患者出现提示术后心肌梗死的持续性心电图改变（P = 0.003）。发现II组患者术后酶水平较低，且在24小时结束时差异具有统计学意义。
这些结果表明，我们的控制性初始再灌注技术在预防缺血再灌注损伤方面是有效的。基于本研究早期的良好结果，我们提倡使用这种创新技术作为复杂的控制性主动脉根部再灌注的替代方法。
