Janssen Carina, Kellermann Stephanie, Münch Frank, Purbojo Ariawan, Cesnjevar Robert Anton, Rüffer André
Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Ann Thorac Surg. 2015 Nov;100(5):1758-66. doi: 10.1016/j.athoracsur.2015.06.017. Epub 2015 Aug 29.
Selective myocardial perfusion enables repair of congenital aortic arch obstruction without cardiac arrest. This study was inspired by the lack of prospective controlled studies of the beating heart (BH) technique compared with cold crystalloid cardioplegia (CC) regarding effects on myocardial performance, ischemic damage, and serum electrolyte levels.
In a prospective study, 20 male piglets weighing 11.1 ± 1.3 kg were operated on using cardiopulmonary bypass (CPB) and underwent 60 minutes of aortic cross-clamping. According to prospective randomization, myocardial protection included either a BH modification with selective myocardial perfusion using an individual roller pump or CC. Hemodynamic performance was evaluated by a conductance catheter technique before and after CPB and calculated in relation to baseline levels. Laboratory analysis included blood levels of troponin T and serum electrolytes.
Eighteen piglets entered analysis. There were significantly higher slopes of end-systolic pressure-volume relations (168% ± 92% versus 89% ± 16%; p = 0.046) and preload-recruitable stroke work (PRSW) (139% ± 37% versus 103% ± 31%; p = 0.040) in BH piglets compared with those who underwent CC. Laboratory analysis during reperfusion revealed higher levels of troponin T (1.31 ± 0.28 ng/mL versus 0.49 ± 0.17 ng/mL; p < 0.01) and sodium (131 ± 4 mmol/L versus 120 ± 8 mmol/L; p = 0.003) and lower levels of potassium (4.8 ± 0.4 mmol/L versus 6.4 ± 1.0 mmol/L; p = 0.001) with BH compared with CC, whereas no significant differences were calculated at the end of the experiment.
The BH technique is associated with improved contractility compared with standard CC. There is comparable ischemic damage in both groups, with an earlier rise in blood levels of troponin T after BH and more fluctuation of serum electrolytes with CC. Evidence of ischemic changes should dissuade one from using the BH technique imprudently.
选择性心肌灌注能够在不停跳的情况下修复先天性主动脉弓梗阻。本研究的灵感来源于，目前缺乏关于跳动心脏（BH）技术与冷晶体停搏液（CC）相比，对心肌性能、缺血损伤和血清电解质水平影响的前瞻性对照研究。
在一项前瞻性研究中，对20只体重为11.1±1.3千克的雄性仔猪进行体外循环（CPB）手术，并进行60分钟的主动脉交叉钳夹。根据前瞻性随机分组，心肌保护措施包括使用单独的滚压泵进行选择性心肌灌注的BH改良法或CC法。在CPB前后通过电导导管技术评估血流动力学性能，并与基线水平进行比较计算。实验室分析包括肌钙蛋白T的血液水平和血清电解质。
18只仔猪进入分析。与接受CC的仔猪相比，BH仔猪的收缩末期压力-容积关系斜率（168%±92%对89%±16%；p = 0.046）和可招募前负荷搏功（PRSW）（139%±37%对103%±31%；p = 0.040）显著更高。再灌注期间的实验室分析显示，与CC相比，BH组的肌钙蛋白T水平更高（1.31±0.28纳克/毫升对0.49±0.17纳克/毫升；p < 0.01）、钠水平更高（131±4毫摩尔/升对120±8毫摩尔/升；p = 0.003）、钾水平更低（4.8±0.4毫摩尔/升对6.4±1.0毫摩尔/升；p = 0.001），而在实验结束时未计算出显著差异。
与标准CC相比，BH技术与改善的收缩性相关。两组的缺血损伤相当，BH后肌钙蛋白T血液水平上升更早，CC组血清电解质波动更大。缺血变化的证据应劝阻人们谨慎使用BH技术。
