Ziazadeh Daniel, Mater Regina, Himelhoch Ben, Borgman Andrew, Parker Jessica L, Willekes Charles L, Timek Tomasz A
Michigan State University College of Human Medicine, Grand Rapids, Michigan.
DeVos Cardiovascular Research Program, Grand Rapids, Michigan.
Semin Thorac Cardiovasc Surg. 2017 Nov 2. doi: 10.1053/j.semtcvs.2017.10.001.
del Nido cardioplegia (DC) offers prolonged cardiac protection with single-dose administration and has been shown to be safe in adult CABG surgery. We set out to evaluate the efficacy of cardiac protection and clinical outcomes of DC versus standard blood cardioplegia (BC) in minimally invasive aortic valve surgery. From August 2011 to May 2016, 178 patients underwent minimally invasive aortic valve replacement (mini-AVR) with BC (n = 101) or DC (n = 77). Ministernotomy or right minithoracotomy was utilized for surgical access. Clinical patient characteristics and data were extracted from our local Society of Thoracic Surgeons (STS) database and the electronic medical record. Patients were propensity matched for age, gender, body mass index, valve size and type, STS score, surgical access, preop creatinine, diabetes, and chronic obstructive pulmonary disease, yielding 63 well-matched pairs. There was no difference in patient age, preoperative creatinine, body mass index, diabetes, chronic obstructive pulmonary disease, or STS score between BC and DC before or after propensity matching. BC patients received both anterograde and retrograde cardioplegias in multiple doses, whereas DC was delivered almost entirely anterograde with 95% of the patients (73/77) receiving a single dose only. DC was associated with decreased cardiopulmonary bypass time (108 ± 24 vs 135 ± 43 minutes, P = 0.001) and aortic cross-clamp time (80 ± 16 vs 102 ± 30 min, P = 0.001) and maximal glucose levels during cardiopulmonary bypass (165 ± 39 vs 202 ± 49 mg/dL, P = 0.001), whereas troponin T level did not differ between DC and BC (0.3 ± 0.29 vs 0.44 ± 1.7 ng/mL, P = 0.7). Preoperative ejection fraction did not change in either BC (64% ± 12% vs 61% ± 10%, P = 0.09) or DC (58% ± 14% vs 57% ± 14%, P = 0.4) after AVR. In minimally invasive AVR surgery, DC provided equivalent myocardial protection and clinical outcomes to BC while simplifying cardioprotective regimen and reducing aortic cross-clamp time. DC was associated with lower cardiopulmonary bypass glucose levels and demonstrated the feasibility of a single-dose administration.
德尔尼多停搏液（DC）单剂量给药可提供长时间的心脏保护，且已证实在成人冠状动脉旁路移植术（CABG）中是安全的。我们旨在评估在微创主动脉瓣手术中，DC与标准血液停搏液（BC）相比的心脏保护效果及临床结局。2011年8月至2016年5月，178例患者接受了BC（n = 101）或DC（n = 77）的微创主动脉瓣置换术（mini-AVR）。采用胸骨上段小切口或右胸小切口进行手术入路。临床患者特征和数据从我们当地的胸外科医师协会（STS）数据库和电子病历中提取。对患者的年龄、性别、体重指数、瓣膜大小和类型、STS评分、手术入路、术前肌酐、糖尿病和慢性阻塞性肺疾病进行倾向匹配，得到63对匹配良好的病例。倾向匹配前后，BC组和DC组在患者年龄、术前肌酐、体重指数、糖尿病、慢性阻塞性肺疾病或STS评分方面均无差异。BC组患者接受多次顺行和逆行停搏液灌注，而DC组几乎完全采用顺行灌注，95%的患者（73/77）仅接受单剂量灌注。DC组与体外循环时间缩短相关（108±24分钟对135±43分钟，P = 0.001）、主动脉阻断时间缩短相关（80±16分钟对102±30分钟，P = 0.001）以及体外循环期间最大血糖水平降低相关（165±39毫克/分升对202±49毫克/分升，P = 0.001），而DC组和BC组之间肌钙蛋白T水平无差异（0.3±0.29纳克/毫升对0.44±1.7纳克/毫升，P = 0.7）。AVR术后，BC组（64%±12%对61%±10%，P = 0.09）和DC组（58%±14%对57%±14%，P = 0.4）的术前射血分数均未改变。在微创AVR手术中，DC与BC提供了同等的心肌保护和临床结局，但简化了心脏保护方案并缩短了主动脉阻断时间。DC组与较低的体外循环血糖水平相关，并证明了单剂量给药的可行性。
