Matzelle Shannon J, Murphy Michelle J, Weightman William M, Gibbs Neville M, Edelman J James B, Passage Jurgen
Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia.
Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia.
Heart Lung Circ. 2014 Sep;23(9):863-8. doi: 10.1016/j.hlc.2014.03.018. Epub 2014 Mar 26.
Our unit began a minimally invasive mitral surgery (MIMS) program utilising antegrade Custodiol solution as the sole cardioplegia. The aim of this paper is to report our results of this program.
PATIENTS/METHODS: Early clinical outcomes were identified and assessed for the first consecutive 100 MIMS patients with comparisons made to a historical group operated via a sternotomy (n=113). The efficacy of myocardial protection was assessed using surrogate outcomes of myocardial protection with serial sodium concentrations also analysed.
Six hours postoperatively 12 patients required inotropic support. Peak troponin-I in the first 24 hours was 5.1 (0.8-40 μg/L [median(range)]. Sodium levels decreased following administration of Custodiol but by six hours postoperatively the sodium had returned to greater than 130 mmol/L in all but five patients. Blood transfusion was smaller in the MIMS versus historical group (RBC 17% vs. 65%). MIMS patients had a shorter duration of ventilation, hospital stay and one-year mortality rate (0%).
In this series of patients undergoing MIMS, single dose antegrade Custodiol offers satisfactory and safe myocardial protection. Early clinical outcomes were also satisfactory. Whilst our findings are observational, they nevertheless support the use of this less invasive approach to mitral surgery using single dose Custodiol for myocardial protection.
我们的科室开展了一项微创二尖瓣手术（MIMS）项目，采用顺行灌注心停搏液作为唯一的心脏停搏方法。本文旨在报告该项目的结果。
患者/方法：确定并评估了连续100例MIMS患者的早期临床结果，并与通过胸骨切开术手术的历史对照组（n = 113）进行比较。使用心肌保护的替代指标评估心肌保护效果，并分析连续钠浓度。
术后6小时，12例患者需要使用正性肌力药物支持。术后24小时肌钙蛋白-I峰值为5.1（0.8 - 40μg/L[中位数（范围）]）。给予心停搏液后钠水平下降，但术后6小时，除5例患者外，所有患者的钠水平均恢复至大于130mmol/L。MIMS组的输血情况少于历史对照组（红细胞：17%对65%）。MIMS患者的通气时间、住院时间和一年死亡率（0%）更短。
在这一系列接受MIMS的患者中，单剂量顺行灌注心停搏液提供了满意且安全的心肌保护。早期临床结果也令人满意。虽然我们的研究结果是观察性的，但它们仍然支持使用这种侵入性较小的二尖瓣手术方法，采用单剂量心停搏液进行心肌保护。
