Department of Pediatric Cardiac Surgery, 65282National Heart Institute, Kuala Lumpur, Malaysia.
Department of Cardiac Anesthesia, 65282National Heart Institute, Kuala Lumpur, Malaysia.
World J Pediatr Congenit Heart Surg. 2020 Nov;11(6):720-726. doi: 10.1177/2150135120936119.
To compare the safety and effectiveness of del Nido cardioplegia with blood-based St Thomas Hospital (BSTH) cardioplegia in myocardial protection in congenital heart surgery.
It is a prospective, open-labeled, randomized controlled study conducted at National Heart Institute, Kuala Lumpur from July 2018 to July 2019. All patients with simple and complex congenital heart diseases (CHD) with good left ventricular function (left ventricular ejection fraction [LVEF] >50%) were included while those with LVEF <50% were excluded. A total of 100 patients were randomized into two groups of 50 each receiving either del Nido or BSTH cardioplegia. Primary end points were the spontaneous return of activity following aortic cross-clamp release and ventricular function between two groups. Secondary end point was myocardial injury as assessed by troponin T levels.
Cardiopulmonary bypass and aortic cross-clamp time, return of spontaneous cardiac activity following the aortic cross-clamp release, the duration of mechanical ventilation, and intensive care unit stay were comparable between two groups. Statistically significant difference was seen in the amount and number of cardioplegia doses delivered ( < .001). The hemodilution was significantly less in the del Nido complex CHD group compared to BSTH cardioplegia ( = .001) but no difference in blood usage ( = .36). The myocardial injury was lesser (lower troponin T release) with del Nido compared to BSTH cardioplegia ( = .6).
Our study showed that both del Nido and BSTH cardioplegia are comparable in terms of myocardial protection. However, single, less frequent, and lesser volume of del Nido cardioplegia makes it more suitable for complex repair.
比较 Del Nido 心脏停搏液与基于血液的圣托马斯医院（BSTH）心脏停搏液在先天性心脏手术中心肌保护中的安全性和有效性。
这是一项于 2018 年 7 月至 2019 年 7 月在吉隆坡国家心脏研究所进行的前瞻性、开放性、随机对照研究。所有左心室功能良好（左心室射血分数 [LVEF]＞50%）的单纯和复杂先天性心脏病（CHD）患者均被纳入研究，而 LVEF＜50%的患者则被排除在外。共有 100 名患者被随机分为两组，每组 50 名，分别接受 Del Nido 或 BSTH 心脏停搏液。主要终点是主动脉阻断释放后自主活动的恢复和两组之间的心室功能。次要终点是通过肌钙蛋白 T 水平评估的心肌损伤。
两组患者体外循环和主动脉阻断时间、主动脉阻断释放后自主活动的恢复、机械通气时间和重症监护病房停留时间无显著差异。两组间给予的心脏停搏液剂量的数量和次数存在显著差异（<0.001）。与 BSTH 心脏停搏液相比，Del Nido 复杂 CHD 组的血液稀释程度显著降低（=0.001），但血液用量无差异（=0.36）。与 BSTH 心脏停搏液相比，Del Nido 心脏停搏液的心肌损伤较小（肌钙蛋白 T 释放较低）（=0.6）。
我们的研究表明，Del Nido 和 BSTH 心脏停搏液在心肌保护方面具有可比性。然而，单次、较少、较少剂量的 Del Nido 心脏停搏液使其更适合复杂修复。
