1st Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland; Center for Cardiovascular Research and Development, American Heart of Poland, Bielsko-Biała, Poland.
1st Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland; Center for Cardiovascular Research and Development, American Heart of Poland, Bielsko-Biała, Poland.
J Thorac Cardiovasc Surg. 2020 Jun;159(6):2275-2283.e1. doi: 10.1016/j.jtcvs.2019.05.083. Epub 2019 Jun 28.
To compare the cardioprotective efficacy of a solution that requires only a single infusion at the start of the ischemic duration versus a solution that requires multiple infusions.
Aortic valve replacement was performed for 150 patients, who were randomized into the del Nido (DN) cardioplegia group or the cold blood (CB) cardioplegia group. The DN cardioplegia was delivered every 90 minutes and the CB cardioplegia was delivered every 20 to 30 minutes, or whenever cardiac activity was observed. The primary endpoints were electrical cardiac activity during crossclamp, ventricular fibrillation during reperfusion, and postoperative troponin and creatine kinase (CK-MB isoenzyme) at 24 and 48 hours.
Electrical activity during crossclamp occurred in 29 (39.7%) patients in the DN group versus 34 (45.3%) patients in the CB group (adjusted P = 1.0). The number of procedures with ventricular fibrillation after removing the crossclamp was 41 (54.7%) in the CB group versus 17 (22.7%) in the DN group (adjusted P = .001; relative risk, 2.41). Troponin values appeared to be lower in the DN group (median, 223.10; interquartile range, 168.35-364.77 pg/mL vs 285.5; 196.20-419.45 pg/mL at 24 hours and 159.60; 125.42-217.20 pg/mL vs 201.60; 160.62-268.45 pg/mL at 48 hours) and CK-MB (median, 14.94; interquartile range, 12.16-20.39 ng/mL vs 17.43; 13.66-22.43 ng/mL at 24 hours and 6.19; 4.41-7.63 ng/mL vs 7.38; 4.74-10.20 ng/mL at 48 hours), but no significance was found.
The del Nido cardioplegia protocol is an acceptable alternative for cold blood cardioplegia in patients undergoing aortic valve replacement.
比较一种仅需在缺血持续时间开始时输注一次的溶液与需要多次输注的溶液的心脏保护效果。
对 150 例主动脉瓣置换患者进行随机分组，分为 del Nido（DN）心脏停搏液组或冷血（CB）心脏停搏液组。DN 心脏停搏液每 90 分钟输注一次，CB 心脏停搏液每 20 至 30 分钟输注一次，或每当观察到心脏活动时输注。主要终点是夹闭期间的电心脏活动、再灌注期间的心室颤动以及术后 24 小时和 48 小时的肌钙蛋白和肌酸激酶同工酶（CK-MB 同工酶）。
DN 组电心脏活动发生在 29 例（39.7%）患者中，CB 组发生在 34 例（45.3%）患者中（调整后 P=1.0）。去除夹闭后出现心室颤动的程序数量在 CB 组为 41 例（54.7%），在 DN 组为 17 例（22.7%）（调整后 P=0.001；相对风险，2.41）。DN 组肌钙蛋白值似乎较低（中位数 223.10；四分位距 168.35-364.77 pg/mL 与 285.5；196.20-419.45 pg/mL 在 24 小时和 159.60；125.42-217.20 pg/mL 与 201.60；160.62-268.45 pg/mL 在 48 小时）和 CK-MB（中位数 14.94；四分位距 12.16-20.39 ng/mL 与 17.43；13.66-22.43 ng/mL 在 24 小时和 6.19；4.41-7.63 ng/mL 与 7.38；4.74-10.20 ng/mL 在 48 小时），但无显著差异。
在接受主动脉瓣置换的患者中，del Nido 心脏停搏液方案是冷血心脏停搏液的一种可接受的替代方案。
