Koeckert Michael S, Smith Deane E, Vining Patrick F, Ranganath Neel K, Beaulieu Thomas, Loulmet Didier F, Zias Elias, Galloway Aubrey C, Grossi Eugene A
Department of Cardiothoracic Surgery, NYU School of Medicine, NYU Langone Health, New York, New York.
J Card Surg. 2018 Feb;33(2):64-68. doi: 10.1111/jocs.13536. Epub 2018 Feb 19.
We analyzed the impact and safety of del Nido Cardioplegia (DNC) in patients undergoing minimally invasive aortic valve replacement (MIAVR).
We analyzed all isolated MIAVR replacements from 5/2013-6/2015 excluding re-operative patients. The approach was a hemi-median sternotomy in all patients. Patients were divided into two cohorts, those who received 4:1 crystalloid:blood DNC solution and those in whom standard 1:4 Buckberg-based cardioplegia (WBC) was used. One-to-one propensity case matching of DNC to WBC was performed based on standard risk factors and differences between groups were analyzed using chi-square and non-parametric methods.
MIAVR was performed in 181 patients; DNC was used in 59 and WBC in 122. Case matching resulted in 59 patients per cohort. DNC was associated with reduced re-dosing (5/59 (8.5%) versus 39/59 (61.0%), P < 0.001) and less total cardioplegia volume (1290 ± 347 mL vs 2284 ± 828 mL, P < 0.001). Antegrade cardioplegia alone was used in 89.8% (53/59) of DNC patients versus 33.9% (20/59) of WBC patients (P < 0.001). Median bypass and aortic cross-clamp times were similar. Clinical outcomes were similar with respect to post-operative hematocrit, transfusion requirements, need for inotropic/pressor support, duration of intensive care unit stay, re-intubation, length of stay, new onset atrial fibrillation, and mortality.
Del Nido cardioplegia usage during MIAVR minimized re-dosing and the need for retrograde delivery. Patient safety was not compromised with this technique in this group of low-risk patients undergoing MIAVR.
我们分析了德尔尼多停搏液（DNC）在接受微创主动脉瓣置换术（MIAVR）患者中的影响及安全性。
我们分析了2013年5月至2015年6月期间所有单纯的MIAVR置换手术，排除再次手术患者。所有患者均采用半正中胸骨切开术。患者被分为两组，一组接受4:1晶体液:血液的DNC溶液，另一组使用标准的1:4基于巴克伯格的停搏液（WBC）。基于标准风险因素对DNC与WBC进行一对一倾向病例匹配，并使用卡方检验和非参数方法分析组间差异。
181例患者接受了MIAVR；59例使用了DNC，122例使用了WBC。病例匹配后每组有59例患者。DNC与再次给药减少相关（5/59（8.5%）对39/59（61.0%），P < 0.001），且总的停搏液用量更少（1290±347 mL对2284±828 mL，P < 0.001）。89.8%（53/59）的DNC患者仅使用顺行停搏液，而WBC患者中这一比例为33.9%（20/59）（P < 0.001）。体外循环和主动脉阻断时间中位数相似。术后血细胞比容、输血需求、使用血管活性药物支持的必要性、重症监护病房住院时间、再次插管、住院时间、新发房颤和死亡率等临床结局相似。
在MIAVR期间使用德尔尼多停搏液可将再次给药和逆行给药需求降至最低。在这组接受MIAVR的低风险患者中，该技术未损害患者安全。
