Gunaydin Serdar, Gunertem Orhan Eren, Babaroglu Seyhan, Kunt Atike Tekeli, McCusker Kevin, Ozisik Kanat
Department of Cardiovascular Surgery, City Hospital Campus, University of Health Sciences, Ankara, Turkey.
Department of Cardiac Surgery, New York Medical College, New York, USA.
Asian Cardiovasc Thorac Ann. 2021 Feb;29(2):77-83. doi: 10.1177/0218492320966434. Epub 2020 Oct 8.
Despite the increasing popularity of single-dose cardioplegia techniques in coronary artery bypass grafting, the time window for successful reperfusion remains unclear. This study aimed to compare different cardioplegic techniques based on early and 30-day clinical outcomes via thorough monitoring.
This prospective cohort study included high-risk patients undergoing coronary artery bypass grafting and receiving 3 different types of cardioplegia between January 2017 and June 2019. Group 1 ( = 101) had a single dose of del Nido cardioplegia, group 2 ( = 92) had a single dose of histidine-tryptophane-ketoglutarate, and group 3 ( = 119) had cold blood cardioplegia. Patients were examined perioperatively by memory loop recording and auto-triggered memory loop recording for 30 days, with documentation of predefined events.
Interleukin-6 and cardiac troponin levels in group 1 were significantly higher than those in groups 2 and 3. The incidence of predefined events as markers of inadequate myocardial protection was significantly higher group 1, with more frequent atrial fibrillation attacks and more hospital readmissions. The readmission rate was 17.6% in group 1, 9% in group 2, and 8% in group 3.
Our data demonstrate the long-term efficacy of cardioplegic techniques, which may become more crucial in high-risk patients who genuinely have a chance to benefit from adjunct myocardial protection. Patients given del Nido cardioplegia had a significantly more prominent inflammatory response and higher troponin levels after cardiopulmonary bypass. This group had issues in the longer term with significantly more cardiac events and a higher rehospitalization rate.
尽管单剂量心脏停搏技术在冠状动脉旁路移植术中越来越受欢迎，但成功再灌注的时间窗仍不明确。本研究旨在通过全面监测，比较基于早期和30天临床结局的不同心脏停搏技术。
这项前瞻性队列研究纳入了2017年1月至2019年6月期间接受冠状动脉旁路移植术并接受3种不同类型心脏停搏液的高危患者。第1组（n = 101）接受单剂量的德尔尼多心脏停搏液，第2组（n = 92）接受单剂量的组氨酸-色氨酸-酮戊二酸，第3组（n = 119）接受冷血心脏停搏液。患者在围手术期通过记忆环路记录和自动触发记忆环路记录进行30天检查，并记录预定义事件。
第1组的白细胞介素-6和心肌肌钙蛋白水平显著高于第2组和第3组。作为心肌保护不足标志物的预定义事件发生率在第1组显著更高，房颤发作更频繁，住院再入院率更高。第1组的再入院率为17.6%，第2组为9%，第3组为8%。
我们的数据证明了心脏停搏技术的长期疗效，这在真正有机会从辅助心肌保护中获益的高危患者中可能变得更为关键。接受德尔尼多心脏停搏液的患者在体外循环后炎症反应明显更突出，肌钙蛋白水平更高。该组在长期存在更多心脏事件和更高再住院率的问题。
