Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Kardiol Pol. 2019 Nov 22;77(11):1040-1046. doi: 10.33963/KP.14964. Epub 2019 Sep 5.
Del Nido (DN) cardioplegia is increasingly popular in adult cardiac surgery. It allegedly allows for up to 90 minutes of safe myocardial ischemia with a single dose.
We aimed to evaluate the benefits of DN cardioplegia.
Of the 2108 patients undergoing coronary or heart valve surgery with the use of cardiopulmonary bypass (CPB) between January 1, 2016, and September 30, 2017, 1236 (59%) received DN and 872 (41%) received cold blood cardioplegia. We retrospectively analyzed the collected data of all consecutive on‑pump patients to assess early mortality and postoperative troponin T release. A multivariable analysis of both outcomes adjusted for propensity to receive DN cardioplegia was performed.
Patients protected with DN cardioplegia had longer CPB and aortic cross‑clamp times (P <0.001) but received fewer doses of cardioplegia. Median postoperative troponin T levels were higher in the DN‑cardioplegia than CB‑cardioplegia group: 0.324 ng/ml (interquartile range [IQR], 0.210-0.559 ng/ml) vs 0.285 ng/ml (IQR, 0.191-0.496 ng/ml); P = 0.01. However, when adjusted for the cross‑clamp time, propensity to receive DN cardioplegia, and other factors, DN cardioplegia was associated with lower postoperative troponin T levels. Early mortality rates did not differ between DN and CB cardioplegia (3.6% vs 3%; P = 0.54).
Del Nido cardioplegia is a safe and effective method of myocardial protection in adults. It allows for a longer redosing interval with a safety profile and mortality comparable to those for CB cardioplegia, as shown by lower troponin T release when corrected for the time of myocardial ischemia.
在成人心脏手术中，Del Nido（DN）心脏停搏液越来越受欢迎。据称，单次剂量可安全缺血 90 分钟。
我们旨在评估 DN 心脏停搏液的益处。
在 2016 年 1 月 1 日至 2017 年 9 月 30 日期间，接受体外循环（CPB）下冠状动脉或心脏瓣膜手术的 2108 例患者中，1236 例（59%）接受 DN 心脏停搏液，872 例（41%）接受冷血心脏停搏液。我们回顾性分析了所有连续体外循环患者的数据，以评估早期死亡率和术后肌钙蛋白 T 释放。对两种结果进行了多变量分析，调整了接受 DN 心脏停搏液的倾向。
接受 DN 心脏停搏液保护的患者 CPB 和主动脉阻断时间更长（P <0.001），但心脏停搏液剂量较少。DN 心脏停搏液组术后肌钙蛋白 T 中位数高于 CB 心脏停搏液组：0.324ng/ml（四分位距 [IQR]，0.210-0.559ng/ml）与 0.285ng/ml（IQR，0.191-0.496ng/ml）；P=0.01。然而，当校正主动脉阻断时间、接受 DN 心脏停搏液的倾向和其他因素后，DN 心脏停搏液与术后肌钙蛋白 T 水平较低相关。DN 心脏停搏液和 CB 心脏停搏液组的早期死亡率无差异（3.6%比 3%；P=0.54）。
DN 心脏停搏液是一种安全有效的成人心肌保护方法。它允许更长的再灌注间隔，安全性和死亡率与 CB 心脏停搏液相当，通过校正心肌缺血时间，肌钙蛋白 T 释放较低。
