Nenna Antonio, Spadaccio Cristiano, Lusini Mario, Nappi Francesco, Mastroianni Ciro, Giacinto Omar, Pugliese Giuseppe, Casacalenda Adele, Barbato Raffaele, Barberi Filippo, Greco Salvatore Matteo, Satriano Umberto, Forte Felice, Miano Nicoletta, Colicchia Camilla, Di Lorenzo Domitilla, Gaudino Mario, Chello Massimo
Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.
Interact Cardiovasc Thorac Surg. 2019 Jul 1;29(1):51-58. doi: 10.1093/icvts/ivz012.
Minimization of bleeding to reduce the use of blood products is of utmost importance in cardiac surgery. Statins are known for their pleiotropic effects beyond lipid-lowering properties, and the use of atorvastatin preoperatively is associated with reduced risk of bleeding and blood product use after coronary surgery. However, no studies have investigated if this beneficial effect also extends to aortic valve surgery.
In this retrospective cohort study, 1145 consecutive patients undergoing elective primary isolated aortic valve replacement meeting the inclusion and exclusion criteria were selected from January 2009 to December 2017 (547 in the atorvastatin group, 598 in the control group). Postoperative bleeding, blood product use, and complications were monitored during hospitalization.
Postoperative bleeding was significantly lower in the atorvastatin group compared with the controls in the first 12 h after surgery (372 ± 137 vs 561 ± 219 ml; P = 0.001) and considering overall bleeding (678 ± 387 vs 981 ± 345 ml, P = 0.001). A total of 32.3% of controls and 26.3% of atorvastatin users received packed red blood cells (P = 0.027), and major surgical complications were similar between the groups. Postoperative length of stay was shorter in the atorvastatin group with an average reduction of 1 day of hospitalization (6.0 ± 1.4 vs 6.9 ± 2.1 days; P = 0.001). Postoperative bleeding among the atorvastatin-treated patients was significantly greater in those taking lower doses compared to those taking higher doses of atorvastatin with a 20% between-group difference (P = 0.001).
Preoperative treatment with atorvastatin might reduce postoperative bleeding and transfusion of packed red blood cells in patients undergoing elective isolated aortic valve replacement. This result might translate into faster recovery after surgery and reduced hospitalization costs.
在心脏手术中，尽量减少出血以减少血制品的使用至关重要。他汀类药物除了具有降脂特性外，还具有多种效应，术前使用阿托伐他汀与冠状动脉手术后出血风险降低及血制品使用减少有关。然而，尚无研究调查这种有益效果是否也适用于主动脉瓣手术。
在这项回顾性队列研究中，从2009年1月至2017年12月选取了1145例连续接受择期原发性孤立主动脉瓣置换术且符合纳入和排除标准的患者（阿托伐他汀组547例，对照组598例）。住院期间监测术后出血、血制品使用及并发症情况。
术后12小时内，阿托伐他汀组的术后出血量显著低于对照组（372±137 vs 561±219毫升；P = 0.001），总体出血量方面也是如此（678±387 vs 981±345毫升，P = 0.001）。共有32.3%的对照组患者和26.3%的阿托伐他汀使用者接受了浓缩红细胞输注（P = 0.027），两组间主要手术并发症相似。阿托伐他汀组的术后住院时间较短，平均住院天数减少1天（6.0±1.4 vs 6.9±2.1天；P = 0.001）。与服用高剂量阿托伐他汀的患者相比，服用低剂量阿托伐他汀的患者术后出血显著更多，组间差异为20%（P = 0.001）。
术前使用阿托伐他汀治疗可能减少择期孤立主动脉瓣置换术患者的术后出血及浓缩红细胞输注。这一结果可能转化为术后更快的恢复及更低的住院费用。
