Goncu M T, Sezen M, Toktas F, Ari H, Gunes M, Tiryakioglu O, Yavuz S
Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey.
J Int Med Res. 2010 Jul-Aug;38(4):1333-42. doi: 10.1177/147323001003800415.
Patients undergoing on-pump coronary artery bypass graft (CABG) with proximal graft anastomosis were randomly divided into groups that received antegrade cardioplegic infusion only via the aortic root (group A) or antegrade cardioplegic infusion via the aortic root and additional cardioplegia via vein or free arterial grafts after completion of each distal anastomosis (group B). The group B patients also received bypass graft perfusion with warm arterial blood just after removal of the cross-clamp until the proximal graft anastomosis was completed. The need for defibrillation and inotropic support during separation from cardiopulmonary bypass (CPB), and total CPB time were significantly lower in group B than in group A. Group B also had significantly lower peak cardiac troponin I levels 12 h after operation compared with group A and this was more pronounced in subgroups with severe right coronary artery stenosis and poor left ventricular ejection fraction than in the whole population. It is concluded that antegrade graft cardioplegia and graft perfusion with warm blood during proximal graft anastomosis may improve myocardial protection.
接受近端移植物吻合的体外循环冠状动脉旁路移植术（CABG）患者被随机分为两组，仅通过主动脉根部接受顺行性心脏停搏液输注的组（A组），或在完成每个远端吻合后通过主动脉根部接受顺行性心脏停搏液输注并通过静脉或游离动脉移植物接受额外心脏停搏液的组（B组）。B组患者在松开主动脉阻断钳后立即用温动脉血进行旁路移植物灌注，直至完成近端移植物吻合。与A组相比，B组在体外循环（CPB）脱离期间对除颤和正性肌力支持的需求以及总CPB时间显著更低。与A组相比，B组术后12小时心脏肌钙蛋白I峰值水平也显著更低，并且在右冠状动脉严重狭窄和左心室射血分数低的亚组中比在总体人群中更明显。结论是，在近端移植物吻合期间进行顺行性移植物心脏停搏和用温血进行移植物灌注可能改善心肌保护。
