Cardiovascular Surgery, Department of Cardiovascular Surgery, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran.
Vascular Surgery, Department of Vascular Surgery, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Surg. 2018 Jul;55:53-59. doi: 10.1016/j.ijsu.2018.05.019. Epub 2018 May 18.
To determine the efficacy of antegrade cardioplegia supplemented with venous graft perfusion in patients scheduled for coronary artery bypass grafting (CABG).
223 consecutive patients scheduled for isolated CABG were randomized to receive either continuous crystalloid cardioplegia via vein grafts on completion of each distal anastomosis plus intermittent blood cardioplegia through aortic root (group 1, n = 110) or antegrade blood cardioplegia alone (group 2, n = 113). Two groups were similar in terms of preoperative patients' and procedural characteristics. The primary end-points were low output syndrome (LOS) variables.
The inotrope and intra-aortic balloon pump demand during weaning were significantly higher in the control group (31.8% vs. 20%, p = 0.043 and 7.9% vs. 1.8%, p = 0.034 respectively). Postoperative level of potassium and arterial base excess (BE), stood in the normal range in both groups, despite significant inter-group differences. Peak serum level of myocardial injury biomarkers (CK, CK-MB, and cTnI) at 12 h following operation, though markedly greater in the group 2, did not reach the cut-off point of myocardial necrosis. Postoperative arrhythmia was more commonly encountered in the control group (p = 0.045). The duration of ventilation and hospital stay were considerably longer in the group 2. In a subgroup with LVEF<30%, the length of ICU stay was more prolonged in the control group, as well (p = 0.0145). The significant differences among groups regarding LOS parameters were more remarkable in the two high-risk subgroups (LVEF<30%, left main coronary stenosis).
Given the better postoperative cardiac performance, we recommend this method to all CABG candidates, particularly in higher-risk patients.
为了确定在冠状动脉旁路移植术（CABG）患者中，前向心脏停搏液联合静脉移植物灌注的疗效。
223 例连续接受单纯 CABG 的患者被随机分为两组，每组 113 例：一组在完成每一个远端吻合后通过静脉移植物给予持续的晶体心脏停搏液，同时通过主动脉根部给予间断的血心脏停搏液（组 1）；另一组仅给予前向血心脏停搏液（组 2）。两组患者的术前患者特征和手术特点相似。主要终点是低心排血量综合征（LOS）变量。
在撤机时，对照组的正性肌力药物和主动脉内球囊反搏的需求明显更高（31.8%比 20%，p=0.043 和 7.9%比 1.8%，p=0.034）。尽管两组间存在显著差异，但两组的术后血钾和动脉碱剩余（BE）水平均在正常范围内。尽管术后 12 小时组 2 的心肌损伤标志物（CK、CK-MB 和 cTnI）的峰值水平明显更高，但未达到心肌坏死的截止点。对照组术后心律失常更为常见（p=0.045）。组 2 的通气和住院时间明显延长。在 LVEF<30%的亚组中，对照组的 ICU 住院时间也更长（p=0.0145）。在 LOS 参数方面，两组间的显著差异在两个高危亚组（LVEF<30%，左主干狭窄）中更为显著。
鉴于术后心脏功能更好，我们建议所有 CABG 患者采用这种方法，尤其是高危患者。
