在联合终末温血停搏液再灌注的长时间单次剂量 Del Nido 心脏停搏液后，左心室功能得到更好的恢复。

Superior restoration of left ventricular performance after prolonged single-dose del Nido cardioplegia in conjunction with terminal warm blood cardioplegic reperfusion.

机构信息

Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan.

出版信息

J Thorac Cardiovasc Surg. 2022 Oct;164(4):e143-e153. doi: 10.1016/j.jtcvs.2020.11.152. Epub 2020 Dec 10.

DOI:10.1016/j.jtcvs.2020.11.152

PMID:33485669

Abstract

OBJECTIVES

An incomplete restoration of left ventricular contractility after del Nido cardioplegia was noted in our recent study. This study tested the hypothesis that terminal warm blood cardioplegia promotes a prompt restoration of left ventricular performance after a prolonged single-dose del Nido cardioplegia.

METHODS

Fourteen piglets were subjected to 120 minutes of arrest by del Nido cardioplegia without terminal warm blood cardioplegia (del Nido cardioplegia group; n = 7) or with terminal warm blood cardioplegia before reperfusion (terminal warm blood cardioplegia group; n = 7). The other 7 piglets underwent total cardiopulmonary bypass without ischemia/reperfusion for 150 minutes (control group). Left ventricular function was assessed by percent recovery of end-systolic elastance as the contractility and percent end-diastolic pressure-volume relationship as the compliance using a conductance catheter. Troponin T and the mitochondrial score were also measured.

RESULTS

Depressed percent recovery of end-systolic elastance was sustained in the del Nido cardioplegia group, and a prompt restoration of end-systolic elastance was achieved using terminal warm blood cardioplegia (57.9 ± 17.8 vs 94.7 ± 13.1, P < .028). Percent end-diastolic pressure-volume relationship at the early phase was better in the terminal warm blood cardioplegia compared with the del Nido group (88.5 ± 24.0 vs 101.4 ± 16.8, P = .050). Troponin T was higher in the terminal warm blood cardioplegia compared with the control group (0.80% ± 0.21% and 1.49% ± 0.31%, respectively, P = .002). The mitochondrial score was equivalent in all groups. Spontaneous restoration to sinus rhythm was more frequent in the terminal warm blood cardioplegia group than in the del Nido cardioplegia group (6/7 vs 1/7, P < .028).

CONCLUSIONS

The supplementary use of terminal warm blood cardioplegia achieved prolongation of the safe ischemic time up to 120 minutes for a single-dose application.

摘要

目的

我们最近的一项研究发现，在使用 Del Nido 心脏停搏液后，左心室收缩力的恢复并不完全。本研究旨在验证以下假设，即在长时间单次应用 Del Nido 心脏停搏液后，终末温血心脏停搏液是否能促进左心室功能的快速恢复。

方法

将 14 头小猪进行 120 分钟的停搏，其中 7 头小猪在复灌前不使用终末温血心脏停搏液（Del Nido 心脏停搏液组；n = 7），7 头小猪使用终末温血心脏停搏液（终末温血心脏停搏液组；n = 7）。另外 7 头小猪在无缺血/再灌注的情况下进行 150 分钟的全心肺旁路（对照组）。使用心阻抗导管测定收缩末期弹性的恢复百分比作为收缩性，舒张末期压力-容积关系的恢复百分比作为顺应性，评估左心室功能。还测定了肌钙蛋白 T 和线粒体评分。

结果

Del Nido 心脏停搏液组的收缩末期弹性恢复百分比持续降低，终末温血心脏停搏液可迅速恢复收缩末期弹性（57.9 ± 17.8% vs 94.7 ± 13.1%，P < 0.028）。与 Del Nido 组相比，终末温血心脏停搏液组在早期舒张末期压力-容积关系更好（88.5 ± 24.0% vs 101.4 ± 16.8%，P = 0.050）。与对照组相比，终末温血心脏停搏液组的肌钙蛋白 T 更高（分别为 0.80% ± 0.21%和 1.49% ± 0.31%，P = 0.002）。所有组的线粒体评分均相当。终末温血心脏停搏液组比 Del Nido 心脏停搏液组更频繁地自发恢复窦性节律（6/7 比 1/7，P < 0.028）。