Pediatric Cardiovascular Surgery Unit, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HC-FMUSP), São Paulo, Brazil.
Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.
Perfusion. 2022 Oct;37(7):684-691. doi: 10.1177/02676591211020471. Epub 2021 Jun 3.
The aim of this study was to evaluate outcome measures between our standard multidose cardioplegia protocol and a del Nido cardioplegia protocol in congenital heart surgery patients.
Retrospective single-center study including 250 consecutive patients that received del Nido cardioplegia (DN group) with a mandatory reperfusion period of 30% of cross clamp time and 250 patients that received a modified St. Thomas' solution (ST group). Groups were matched by age, weight, gender, and Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores. Preoperative hematocrit and oxygen saturation were also recorded. Outcomes analyzed were the vasoactive inotropic score (VIS), lactate, ventilation time, ventricular dysfunction with low cardiac output syndrome (LCOS), intensive care unit (ICU) length of stay (LOS), hospital LOS, bypass and aortic cross-clamp times, and in-hospital mortality.
Both groups were comparable demographically. Statistically significant differences (p ⩽ 0.05) were noted for cardiac dysfunction with LCOS, hematocrit at end of surgery (p = 0.0038), VIS on ICU admission and at end of surgery (p = 0.0111), and ICU LOS (p = 0.00118) with patients in the DN group having more desirable values for those parameters. Other outcome measures did not reach statistical significance.
In our congenital cardiac surgery population, del Nido cardioplegia strategy was associated with less ventricular dysfunction with LCOS, a lower VIS and decreased ICU LOS compared with patients that received our standard myocardial protection using a modified St. Thomas' solution. Despite the limitation of this study, including its retrospective nature and cohort size, these data supported our transition to incorporate del Nido cardioplegia solution with a mandatory reperfusion period as the preferred myocardial protection method in our program.
本研究旨在评估我们的标准多次剂量心脏停搏液方案与 Del Nido 心脏停搏液方案在先天性心脏病手术患者中的结果测量指标。
回顾性单中心研究纳入 250 例连续接受 Del Nido 心脏停搏液（DN 组）的患者，其强制性再灌注时间为体外循环夹闭时间的 30%，并纳入 250 例接受改良的 St. Thomas 溶液（ST 组）的患者。两组患者的年龄、体重、性别和先天性心脏病手术风险调整（RACHS-1）评分匹配。还记录了术前血细胞比容和氧饱和度。分析的结果包括血管活性正性肌力评分（VIS）、乳酸、通气时间、低心输出量综合征（LCOS）的心室功能障碍、重症监护病房（ICU）住院时间（LOS）、医院 LOS、体外循环和主动脉阻断时间以及住院死亡率。
两组患者在人口统计学上具有可比性。统计学上显著差异（p ⁇ 0.05）为 LCOS 时的心脏功能障碍、手术结束时的血细胞比容（p ⁇ 0.0038）、ICU 入院时和手术结束时的 VIS（p ⁇ 0.0111）和 ICU LOS（p ⁇ 0.00118），DN 组患者在这些参数上的数值更理想。其他结果测量指标未达到统计学意义。
在我们的先天性心脏手术患者中，与接受我们使用改良的 St. Thomas 溶液的标准心肌保护方案的患者相比，Del Nido 心脏停搏液策略与 LCOS 时的心室功能障碍减少、VIS 较低和 ICU LOS 缩短相关。尽管这项研究存在局限性，包括其回顾性和队列规模，但这些数据支持我们过渡到采用 Del Nido 心脏停搏液与强制性再灌注期作为我们方案中的首选心肌保护方法。
