Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
J Cardiothorac Vasc Anesth. 2019 May;33(5):1197-1204. doi: 10.1053/j.jvca.2018.11.042. Epub 2018 Nov 28.
To compare myocardial protection with retrograde cardioplegia alone with antegrade and retrograde cardioplegia in minimally invasive mitral valve surgery (MIMS).
Retrospective study.
Tertiary care university hospital.
The authors studied 97 MIMS patients using retrograde cardioplegia alone and 118 MIMS patients using antegrade and retrograde cardioplegia.
The data from patients admitted for MIMS using retrograde cardioplegia (MIMS retro) between 2009 to 2012 were compared with the data from patients undergoing MIMS with antegrade and retrograde cardioplegia (MIMS ante-retro) between 2006 and 2010 (control group). Cardioplegia in the MIMS retro group was delivered solely through an endovascular coronary sinus (CS) catheter positioned under echographic and fluoroscopic guidance. Antegrade and retrograde cardioplegia was used in the MIMS ante-retro group. Data regarding myocardial infarction (MI; creatine kinase Mb, troponin T, electrocardiogram), myocardial function, and hemodynamic stability were collected for comparison.
Adequate cardioplegia administration (CS pressure >30 mmHg and asystole) was attained in 74.2% of the patients with retrograde cardioplegia alone. In 23.7% of the patients, the addition of an antegrade cardioplegia was necessary. No difference was observed in the incidence of MI (0 MIMS retro v 1 for MIMS ante-retro, p = 0.3623), difficult separation from cardiopulmonary bypass, and postoperative malignant arrhythmia. No difference was found for maximal creatine kinase Mb (39.1 [28.0-49.1] v 37.9 [28.6-50.9]; p = 0.8299) and for maximal troponin T levels (0.39 [0.27-0.70] v 0.47 [0.32-0.79]; p = 0.1231) for MIMS retro and MIMS ante-retro, respectively. However, lactate levels in the MIMS retro group were significantly lower than in the MIMS ante-retro group (2.1 [1.4-3.05] v 2.4 [1.8-3.3], respectively; p = 0.0453). No difference was observed in duration of intensive care unit stay and death. MIMS retro patients had a shorter hospital stay (7.0 [6.0-8.0] v 8.0 [7.0-9.0] days; p = 0.0003).
Retrograde cardioplegia administration alone provided comparable myocardial protection to antegrade and retrograde cardioplegia during MIMS, but was not sufficient to achieve asystole in one-fifth of patients.
比较微创二尖瓣手术（MIMS）中单纯逆行灌注与顺行和逆行灌注心肌保护的效果。
回顾性研究。
三级护理大学医院。
作者研究了 97 例单纯使用逆行灌注的 MIMS 患者和 118 例使用顺行和逆行灌注的 MIMS 患者。
比较 2009 年至 2012 年期间使用逆行灌注的 MIMS 患者（MIMS 逆行组）的数据与 2006 年至 2010 年期间接受顺行和逆行灌注的 MIMS 患者（对照组）的数据。MIMS 逆行组的心脏停搏液仅通过超声和透视引导下的血管内冠状窦（CS）导管输送。MIMS 顺行逆行组使用顺行和逆行心脏停搏液。收集心肌梗死（肌酸激酶 Mb、肌钙蛋白 T、心电图）、心肌功能和血流动力学稳定性的数据进行比较。
单纯逆行灌注组 74.2%的患者达到了足够的心脏停搏液（CS 压力>30mmHg 并出现停搏）。在 23.7%的患者中，需要添加顺行灌注。逆行灌注组 MI（0 例 MIMS 逆行与 1 例 MIMS 顺行逆行，p=0.3623）、与体外循环分离困难和术后恶性心律失常的发生率无差异。最大肌酸激酶 Mb（39.1[28.0-49.1]vs 37.9[28.6-50.9]；p=0.8299）和最大肌钙蛋白 T 水平（0.39[0.27-0.70]vs 0.47[0.32-0.79]；p=0.1231）在 MIMS 逆行组和 MIMS 顺行逆行组之间无差异。然而，MIMS 逆行组的乳酸水平明显低于 MIMS 顺行逆行组（分别为 2.1[1.4-3.05]vs 2.4[1.8-3.3]；p=0.0453）。两组 ICU 住院时间和死亡率无差异。MIMS 逆行组患者的住院时间较短（7.0[6.0-8.0]vs 8.0[7.0-9.0]天；p=0.0003）。
在 MIMS 中，单纯逆行心脏停搏液与顺行和逆行心脏停搏液提供了相当的心肌保护，但在五分之一的患者中未能达到停搏。
