Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa; Adventist HealthCare, Takoma Park, Md; Inova Fairfax Hospital, Falls Church, Va.
Heart and Vascular Institute, West Virginia University Medicine, Morgantown, WVa.
J Thorac Cardiovasc Surg. 2018 Mar;155(3):1011-1018. doi: 10.1016/j.jtcvs.2017.09.146. Epub 2017 Nov 13.
The del Nido cardioplegia solution has been used extensively in congenital heart surgery for more than 20 years and more recently for adults. This randomized controlled trial examined whether expanding this technique to adult cardiac surgery confers benefits in surgical workflow and clinical outcome compared with blood-based cardioplegia.
Adult first-time coronary artery bypass grafting (CABG), valve, or CABG/valve surgery patients requiring cardiopulmonary bypass (CPB) were randomized to del Nido cardioplegia (n = 48) or whole blood cardioplegia (n = 41). Primary outcomes assessed myocardial preservation. Troponin I was measured at baseline, 2 hours after CPB termination, 12 and 24 hours after cardiovascular intensive care unit admission. Alpha was set at P < .001.
Preoperative characteristics were similar between groups, including age, Society of Thoracic Surgeons risk score, CABG, and valve procedures. There was no significant difference on CPB time (97 vs 103 minutes; P = .288) or crossclamp time (70 vs 83 minutes; P = .018). The del Nido group showed higher return to spontaneous rhythm (97.7% vs 81.6%; P = .023) and fewer patients required inotropic support (65.1% vs 84.2%; P = .050), but did not reach statistical significance. Incidence of Society of Thoracic Surgeons-defined morbidity was low, with no strokes, myocardial infarctions, renal failure, or operative deaths. For del Nido group patients, troponin levels did not increase as much as for control patients (P = .040), but statistical significance was not reached.
Evidence from this study suggests del Nido cardioplegia use in routine adult cases may be safe, result in comparable clinical outcomes, and streamline surgical workflow. The trend for troponin should be investigated further because it may suggest superior myocardial protection with the del Nido solution.
Del Nido 心脏停搏液在先天性心脏病手术中已应用超过 20 年，最近也用于成人心脏手术。本随机对照试验旨在研究将该技术扩展到成人心脏手术是否比基于血液的心脏停搏液在手术流程和临床结局方面具有优势。
接受体外循环（CPB）的成人首次冠状动脉旁路移植术（CABG）、瓣膜或 CABG/瓣膜手术患者被随机分为 Del Nido 心脏停搏液组（n=48）或全血心脏停搏液组（n=41）。主要结局评估心肌保护。在 CPB 结束后 2 小时、心血管重症监护病房（CICU）入院后 12 小时和 24 小时测量肌钙蛋白 I。α值设定为 P<0.001。
两组患者的术前特征相似，包括年龄、胸外科医师协会风险评分、CABG 和瓣膜手术。CPB 时间（97 分钟 vs 103 分钟；P=0.288）或主动脉阻断时间（70 分钟 vs 83 分钟；P=0.018）无显著差异。Del Nido 组患者自主心律恢复率更高（97.7% vs 81.6%；P=0.023），需要正性肌力支持的患者更少（65.1% vs 84.2%；P=0.050），但未达到统计学意义。符合胸外科医师协会定义的发病率较低，无卒中和心肌梗死、肾衰竭或手术死亡。对于 Del Nido 组患者，肌钙蛋白水平升高幅度不如对照组患者（P=0.040），但未达到统计学意义。
本研究证据表明，在常规成人病例中使用 Del Nido 心脏停搏液可能是安全的，可获得相当的临床结局，并简化手术流程。还需要进一步研究肌钙蛋白的趋势，因为这可能表明 Del Nido 溶液具有更好的心肌保护作用。
