Kuhn Elmar W, Liakopoulos Oliver, Slottosch Ingo, Deppe Antje Christin, Choi Yeong-Hoon, Madershahian Navid, Wahlers Thorsten C W
Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany.
Thorac Cardiovasc Surg. 2018 Sep;66(6):457-463. doi: 10.1055/s-0037-1612604. Epub 2017 Dec 31.
Choice of cardioplegic solution plays a pivotal role in special subgroups of patients referred for on-pump cardiac surgery. This retrospective analysis aimed to assess the impact of intermittent warm (Calafiore, Cala) versus intermittent cold blood cardioplegia (Buckberg, Buck) in patients referred to coronary artery bypass graft (CABG) surgery due to acute coronary syndromes (ACS).
From 2008 to 2015, all consecutive patients undergoing urgent on-pump CABG surgery due to ACS ( = 950) were retrospectively analyzed. Intraoperative cardiac arrest was achieved using Buck ( = 273) or Cala ( = 677). Patients were compared regarding clinical outcomes and perioperative myocardial injury (PMI). Propensity score matching was performed to control for differences in preoperative patient characteristics.
Prevalences of left main stenosis >50%, COPD, and advanced New York Heart Association (NYHA) class were higher for intermittent warm blood cardioplegia (IWC)-patients while more Buck-patients had preoperative intra-aortic balloon pump (IABP) and redo procedures. Buck-patients needed more intraoperative defibrillations and showed longer cardiopulmonary bypass (CPB) and aortic clamping times. 30-day all-cause mortality (10.6 versus 9.3%), major adverse cardiac events (MACE) (52.7 versus 48.6%), and PMI (50.5 versus 55.7%; all > 0.05) rates were comparable for Buck- and Cala-patients. Propensity score matching resulted in equal group sizes ( = 212 each) and balanced distribution of preoperative covariates. Although more Buck-patients still needed inotropic support >24 hours postoperatively (25.7 versus 14.7%; = 0.005) compared with Cala-group, outcome variables of interest did not differ between treatment groups (30-day mortality: 7.5 versus 9.0%; MACE: 49.5 versus 40.6%; PMI: 48.1 versus 37.3%; all > 0.05).
Buckberg and Calafiore cardioplegia offer comparable myocardial protection and similar postoperative results in patients undergoing CABG surgery due to ACS.
在接受心脏搭桥手术的特定患者亚组中，心脏停搏液的选择起着关键作用。本回顾性分析旨在评估间歇性温血（卡拉菲奥雷，Cala）与间歇性冷血心脏停搏液（巴克伯格，Buck）对因急性冠状动脉综合征（ACS）接受冠状动脉旁路移植术（CABG）的患者的影响。
回顾性分析2008年至2015年期间所有因ACS接受紧急心脏搭桥手术的连续患者（n = 950）。术中使用Buck（n = 273）或Cala（n = 677）实现心脏停搏。比较患者的临床结局和围手术期心肌损伤（PMI）。进行倾向评分匹配以控制术前患者特征的差异。
间歇性温血心脏停搏液（IWC）组患者左主干狭窄>50%、慢性阻塞性肺疾病（COPD）和纽约心脏协会（NYHA）心功能分级较高，而更多Buck组患者有术前主动脉内球囊反搏（IABP）和再次手术。Buck组患者需要更多术中除颤，且体外循环（CPB）和主动脉阻断时间更长。Buck组和Cala组患者的30天全因死亡率（10.6%对9.3%）、主要不良心脏事件（MACE）（52.7%对48.6%）和PMI（50.5%对55.7%；均P>0.05）发生率相当。倾向评分匹配后两组样本量相等（每组n = 212），术前协变量分布均衡。尽管与Cala组相比，更多Buck组患者术后仍需要超过24小时的正性肌力支持（25.7%对14.7%；P = 0.005），但各治疗组感兴趣的结局变量无差异（30天死亡率：7.5%对9.0%；MACE：49.5%对40.6%；PMI：48.1%对37.3%；均P>0.05）。
对于因ACS接受CABG手术的患者，巴克伯格和卡拉菲奥雷心脏停搏液提供了相当的心肌保护和相似的术后结果。
