Pizano Alejandro, Montes Felix Ramon, Carreño Marisol, Echeverri Dario, Umaña Juan Pablo
Vascular Function Research Laboratory, Fundación CardioInfantil - Instituto de Cardiología, Colombia.
Department of Anesthesiology, Fundación CardioInfantil – Instituto de Cardiología, Universidad del Rosario, Bogotá, Colombia
Heart Surg Forum. 2018 May 11;21(3):E158-E164. doi: 10.1532/hsf.1920.
Choosing a cardioplegic solution is a significant issue in modern cardiac surgery. Although different options are available, the optimal strategy for myocardial protection has not been established. The aim of this study was to compare intraoperative and postoperative effects of histidine-tryptophan-ketoglutarate (HTK) solution with those of standard blood cardioplegia with St Thomas No 2 solution. The study was conducted using a large cohort of adult patients undergoing complex cardiac surgery.
This study was a single center retrospective review of prospectively collected data. Between January 2008 and December 2015, 4480 patients underwent cardiac surgery using cardiopulmonary bypass (CPB) and cardioplegic arrest. Patients were divided into a blood cardioplegia group (n = 3852) and an HTK solution group (n = 628). Propensity score matching was used to adjust for differences between the two groups, and 292 matched pairs were identified. The primary end point was Intensive Care Unit (ICU) length of stay (LOS). Secondary end points included intraoperative changes in serum sodium concentration, readmission to ICU, transfusion of blood products, 30-day hospital readmission, 30-day mortality, and the incidence of major postoperative complications. Results: No significant differences were found between the matched groups with regard to baseline characteristics. Aortic cross-clamp and CPB times were longer for the blood cardioplegia (147.4 versus 132.8 min; P < .001). Administration of HTK solution was associated with acute and transient hyponatremia (141 versus 130 mmol/L; P < .001). ICU LOS was comparable between the groups (5.4 versus 5.4 days; P = .585). No significant differences were noted in any other secondary end point.
During complex cardiac surgery, both cardioplegia techniques were equivalent in terms of early clinical outcomes.
在现代心脏手术中，选择心脏停搏液是一个重要问题。尽管有不同的选择，但尚未确定心肌保护的最佳策略。本研究的目的是比较组氨酸 - 色氨酸 - 酮戊二酸（HTK）溶液与标准含血心脏停搏液（St Thomas No 2溶液）的术中和术后效果。该研究使用了一大群接受复杂心脏手术的成年患者进行。
本研究是对前瞻性收集的数据进行的单中心回顾性分析。在2008年1月至2015年12月期间，4480例患者接受了使用体外循环（CPB）和心脏停搏的心脏手术。患者分为含血心脏停搏液组（n = 3852）和HTK溶液组（n = 628）。采用倾向评分匹配来调整两组之间的差异，确定了292对匹配对。主要终点是重症监护病房（ICU）住院时间（LOS）。次要终点包括血清钠浓度的术中变化、再次入住ICU、血液制品输注、30天再入院、30天死亡率以及主要术后并发症的发生率。结果：匹配组之间在基线特征方面未发现显著差异。含血心脏停搏液组的主动脉阻断和CPB时间更长（147.4对132.8分钟；P <.001）。HTK溶液的使用与急性和短暂性低钠血症相关（141对130 mmol/L；P <.001）。两组之间的ICU住院时间相当（5.4对5.4天；P =.585）。在任何其他次要终点方面均未发现显著差异。
在复杂心脏手术期间，两种心脏停搏技术在早期临床结果方面相当。
