Lee Ji-Hyun, Lee Ji-Eun, Shin Jungho, Song In-Kyung, Kim Hee-Soo, Kim Chong-Sung, Kim Woong-Han, Kim Jin-Tae
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongnogu, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Jongnogu, Seoul, Republic of Korea.
Interact Cardiovasc Thorac Surg. 2017 Sep 1;25(3):370-376. doi: 10.1093/icvts/ivx148.
This study aimed to compare the effects of hypothermic ventricular fibrillation and beating-heart techniques during cardiopulmonary bypass (CPB) on postoperative outcomes after simple pulmonary valve replacement in patients with repaired tetralogy of Fallot (TOF).
We retrospectively reviewed the data of 47 patients with repaired tetralogy of Fallot at a single institution, who received pulmonary valve replacement under the ventricular fibrillation or beating-heart technique without cardioplegic cardiac arrest during CPB between January 2005 and April 2015.
The patients were divided into fibrillation (n = 32) and beating-heart (n = 15) groups. On comparing these groups, the fibrillation group had a larger sinotubular junction (27.1 ± 4.6 vs 22.1 ± 2.4 mm), had a longer operation duration (396 ± 108 vs 345 ± 57 min), required more postoperative transfusions (2.1 ± 2.6 vs 5.0 ± 6.3 units) and had a higher vasoactive-inotropic score at intensive care unit admission (8.0 vs 10, all P < 0.05). Echocardiographic data indicated that the systolic internal diameter of the left ventricle was larger in the fibrillation group than in the beating-heart group immediately after surgery and at the 1-year follow-up. Major adverse cardiac events occurred in 3 cases, all from the fibrillation group. Among 7 patients from the fibrillation group with transoesophageal echocardiography data during CPB, 6 had fully opened aortic valves during fibrillation, causing flooding into the left ventricle and left ventricle distension.
The postoperative outcomes are worse with the ventricular fibrillation technique than with the beating-heart technique during CPB for pulmonary valve replacement in patients with repaired tetralogy of Fallot.
本研究旨在比较法洛四联症（TOF）修复术后患者在体外循环（CPB）期间采用低温室颤和心脏不停跳技术进行单纯肺动脉瓣置换术后的效果。
我们回顾性分析了一家机构47例法洛四联症修复术后患者的数据，这些患者于2005年1月至2015年4月期间在CPB下接受了室颤或心脏不停跳技术的肺动脉瓣置换术，术中未进行心脏停搏。
患者分为室颤组（n = 32）和心脏不停跳组（n = 15）。比较两组发现，室颤组的窦管交界更大（27.1±4.6 vs 22.1±2.4mm），手术时间更长（396±108 vs 345±57分钟），术后输血更多（2.1±2.6 vs 5.0±6.3单位），重症监护病房入院时血管活性药物-正性肌力药物评分更高（8.0 vs 10，所有P < 0.05）。超声心动图数据显示，术后即刻及1年随访时，室颤组左心室收缩内径大于心脏不停跳组。主要不良心脏事件发生3例，均来自室颤组。在CPB期间有经食管超声心动图数据的7例室颤组患者中，6例在室颤期间主动脉瓣完全开放，导致血液涌入左心室并引起左心室扩张。
对于法洛四联症修复术后患者进行肺动脉瓣置换术，CPB期间采用室颤技术的术后效果比心脏不停跳技术差。
