Department of Surgery, Montreal Heart Institute, Montreal, Québec, Canada.
Department of Surgery, Montreal Heart Institute, Montreal, Québec, Canada; Department of Surgery, Sainte-Justine Hospital, Montreal, Québec, Canada.
J Thorac Cardiovasc Surg. 2021 Aug;162(2):514-522.e2. doi: 10.1016/j.jtcvs.2020.01.022. Epub 2020 Jan 30.
Del Nido cardioplegia solution offers prolonged cardiac protection with single-dose administration; this is particularly interesting for aortic root surgery. However, there is a scarcity of data supporting its safety in adults undergoing complex cardiac surgery, such as aortic root repair. We hypothesized that del Nido cardioplegia solution and blood cardioplegia solution provide equivalent safety during aortic root surgery.
Between January 2015 and June 2018, 283 consecutive patients undergoing the Ross procedure (204) and valve-sparing operation (79) with del Nido cardioplegia solution or blood cardioplegia solution were 1:1 propensity matched (110 aortic root surgery), and outcomes were compared. Clinical patient characteristics and data were extracted from our local database for valve-sparing operations and for Ross procedures.
Preoperative characteristics were similar between del Nido cardioplegia solution and blood cardioplegia solution after propensity matching (mean age, 48.6 ± 1.5 years). Median postoperative creatine kinase MB isotype did not differ between del Nido cardioplegia solution and blood cardioplegia solution (48.9 [14.9-300] μg/L vs 51.2 [12.4-116] μg/L for blood cardioplegia solution [P = .1]), but there was a trend toward higher troponin T levels with del Nido cardioplegia solution (748 [221-5834] ng/L vs 710 [212-3332] ng/L for blood cardioplegia solution [P = .07]). In patients with myocardial ischemia longer than 180 minutes, median creatine kinase MB isotype was higher in del Nido cardioplegia solution (75.1 [59.3-300] μg/L than in blood cardioplegia solution 60.5 [16.5-116] μg/L [P = .01]). Aortic crossclamp and cardiopulmonary bypass times were shorter with del Nido cardioplegia solution (163 ± 5 vs 181 ± 5 minutes, P = .01 and 145 ± 4 vs 161 ± 4 minutes, respectively, P = .006). Return to spontaneous rhythm was more frequent in the del Nido cardioplegia solution group (52% [29/55] vs 27% [15/55], P = .006). There was no difference in inotropic or vasoactive agent use (P = .8). Postoperative left ventricle ejection fraction was similar (0.54 ± 0.09 vs 0.55 ± 0.08 for del Nido cardioplegia solution and blood cardioplegia solution, respectively; P = .4). There was no difference between groups for perioperative mortality and postoperative complications.
Del Nido cardioplegia solution can be used as an alternative to blood cardioplegia solution in adults undergoing complex aortic root surgery, providing comparable clinical outcomes and improved surgical workflow. However, del Nido cardioplegia solution seems to be associated with increased myocardial injury, especially with extended myocardial ischemic times, but this finding did not translate into adverse clinical events. Caution is warranted in adopting this cardioplegic solution in aortic interventions requiring long ischemic times, and further study is required to establish its exact role in complex cardiac surgery.
单次使用 Del Nido 心脏停搏液可提供延长的心脏保护，这对于主动脉根部手术尤其有趣。然而，在接受复杂心脏手术（如主动脉根部修复）的成人中，支持其安全性的数据却很少。我们假设在主动脉根部手术中，Del Nido 心脏停搏液和血心停搏液提供等效的安全性。
2015 年 1 月至 2018 年 6 月，283 例连续接受 Ross 手术（204 例）和保留瓣膜手术（79 例）的患者，用 Del Nido 心脏停搏液或血心停搏液 1:1 进行倾向匹配（110 例主动脉根部手术），并比较了结果。从我们的瓣膜保留手术和 Ross 手术的本地数据库中提取临床患者特征和数据。
倾向匹配后，Del Nido 心脏停搏液和血心停搏液的术前特征相似（平均年龄，48.6±1.5 岁）。Del Nido 心脏停搏液和血心停搏液的术后肌酸激酶同工酶 MB 中位数无差异（48.9[14.9-300]μg/L 与 51.2[12.4-116]μg/L，血心停搏液[P=0.1]），但 Del Nido 心脏停搏液的肌钙蛋白 T 水平有升高趋势（748[221-5834]ng/L 与 710[212-3332]ng/L，血心停搏液[P=0.07]）。在心肌缺血时间超过 180 分钟的患者中，Del Nido 心脏停搏液的肌酸激酶同工酶 MB 中位数更高（75.1[59.3-300]μg/L 比血心停搏液 60.5[16.5-116]μg/L [P=0.01]）。Del Nido 心脏停搏液的主动脉阻断和体外循环时间更短（163±5 与 181±5 分钟，P=0.01 和 145±4 与 161±4 分钟，P=0.006）。Del Nido 心脏停搏液组自主心律恢复更频繁（52%[29/55]与 27%[15/55]，P=0.006）。正性肌力和血管活性药物的使用无差异（P=0.8）。术后左心室射血分数相似（Del Nido 心脏停搏液组 0.54±0.09 与血心停搏液组 0.55±0.08，P=0.4）。两组之间围手术期死亡率和术后并发症无差异。
Del Nido 心脏停搏液可作为成人复杂主动脉根部手术中血心停搏液的替代物，提供相似的临床结果和改善手术流程。然而，Del Nido 心脏停搏液似乎与心肌损伤增加有关，尤其是在心肌缺血时间延长的情况下，但这一发现并未转化为不良临床事件。在需要长时间缺血的主动脉介入中使用这种心脏停搏液时应谨慎，并需要进一步研究来确定其在复杂心脏手术中的确切作用。
