Kim Sang Yoon, Cho Sungkyu, Lee Ji-Hyun, Kim Jin-Tae, Kim Woong-Han
Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea.
Artif Organs. 2017 Nov;41(11):988-996. doi: 10.1111/aor.12898. Epub 2017 Jul 2.
The objective of this study is to examine the myocardial protective effect of antegrade cardioplegic cardiac arrest (ACC) versus ventricular fibrillation (VF) on short-term and mid-term left ventricular (LV) function in right ventricular outflow tract (RVOT) surgery. RVOT operations conducted from January 2006 to December 2015 were reviewed. The numbers of cases using ACC and VF were 71 and 49, respectively. Postoperative mortality and morbidity were compared between the two groups. Before and after propensity score matching, left ventricular ejection fraction (LVEF) and left ventricular end-systolic/end-diastolic diameter (LVESD/LVEDD) in echocardiography were measured immediately after operation and at mid-term follow-up between postoperative 6 and 24 months. There was no perioperative mortality or cerebrovascular accident. There was no statistically significant difference in the incidence of ventricular and atrial arrhythmia. In the overall patient group, LVESD was significantly decreased in the ACC group compared to the VF group immediately after operation (-0.65 ± 3.55 mm vs. 2.99 ± 4.98 mm, P = 0.001). Mid-term follow-up data demonstrated that LVEF at midterm was higher in the ACC group than in the VF group (64.80% ± 7.40% vs. 60.24% ± 7.93%, P = 0.022). However, the increased amount compared to preoperative value was not statistically significant (1.94% ± 12.65% vs. -2.94% ± 9.41%, P = 0.059). After propensity score matching, the LVEF was significantly improved in the ACC group compared to the VF group at the mid-term follow-up (6.16% ± 6.77% vs. -5.41% ± 9.05%, P = 0.001). Multiple linear regression model demonstrated that lower preoperative LVEF, ACC rather than VF, and exclusion of RVOT reconstruction procedure were positive prognostic factors for the improvement of LVEF at mid-term follow up. The results of this study suggest that myocardial protection using ACC is safe and may be more beneficial in LV function recovery up to the mid-term follow-up after pulmonary valve replacement and other RVOT procedures.
本研究的目的是探讨在右心室流出道（RVOT）手术中，顺行性心脏停搏（ACC）与心室颤动（VF）对短期和中期左心室（LV）功能的心肌保护作用。回顾了2006年1月至2015年12月期间进行的RVOT手术。使用ACC和VF的病例数分别为71例和49例。比较了两组的术后死亡率和发病率。在倾向评分匹配前后，在术后立即以及术后6至24个月的中期随访时，通过超声心动图测量左心室射血分数（LVEF）和左心室收缩末期/舒张末期直径（LVESD/LVEDD）。围手术期无死亡或脑血管意外发生。室性和房性心律失常的发生率无统计学显著差异。在总体患者组中，术后立即ACC组的LVESD较VF组显著降低（-0.65±3.55mm对2.99±4.98mm，P = 0.001）。中期随访数据显示，ACC组中期的LVEF高于VF组（64.80%±7.40%对60.24%±7.93%，P = 0.022）。然而，与术前值相比增加的量无统计学显著差异（1.94%±12.65%对-2.94%±9.41%，P = 0.059）。倾向评分匹配后，中期随访时ACC组的LVEF较VF组显著改善（6.16%±6.77%对-5.41%±9.05%，P = 0.001）。多元线性回归模型表明，术前较低的LVEF、采用ACC而非VF以及排除RVOT重建手术是中期随访时LVEF改善的阳性预后因素。本研究结果表明，在肺动脉瓣置换术和其他RVOT手术中，使用ACC进行心肌保护是安全的，并且在中期随访前对左心室功能恢复可能更有益。
