Barbero Cristina, Rinaldi Mauro, Pocar Marco, Cura Stura Erik, Calia Claudia, Sebastiano Viviana, Marchetto Giovanni, Filippini Claudia, Boffini Massimo, Ricci Davide
Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Front Cardiovasc Med. 2021 Sep 9;8:719687. doi: 10.3389/fcvm.2021.719687. eCollection 2021.
Perfusion strategies and aortic clamping techniques for right mini-thoracotomy mitral valve (MV) surgery have evolved over time and remarkable short- and long-term results have been reported. However, some concerns have raised about the adequacy of myocardial protection during the minimally invasive approach, particularly with the endo-aortic clamp (EAC). Aim of this study was to compare the efficacy, in terms of myocardial preservation, of the EAC with the trans-thoracic aortic clamp (TTC) in patients undergoing right mini-thoracotomy MV surgery. A single center, prospective observational study was performed on patients undergoing right mini-thoracotomy MV surgery with retrograde arterial perfusion and EAC or TTC. A propensity matched analysis was performed to compare the two groups. Primary outcome was the comparison between cardiac troponin T levels measured at different time-points after surgery. Eighty EAC patients were compared with 37 TTC patients. No cases of myocardial infarction or low cardiac-output syndrome were overall reported. No differences were recorded in terms of stroke, peri-operative mortality, and in the release of myocardial markers, lactates levels and need for inotropic support at different time-points after surgery. CK-MB peak levels were significantly lower in the EAC group. Despite concerns arising about the EAC, this prospective study shows equivalence in terms of myocardial preservation of the EAC compared with the TTC in patients undergoing right mini-thoracotomy MV surgery.
随着时间的推移，右胸小切口二尖瓣（MV）手术的灌注策略和主动脉阻断技术不断发展，已有显著的短期和长期效果报道。然而，对于微创方法中心肌保护的充分性存在一些担忧，特别是使用主动脉内阻断钳（EAC）时。本研究的目的是比较在接受右胸小切口MV手术的患者中，EAC与经胸主动脉阻断钳（TTC）在心肌保护方面的疗效。对接受右胸小切口MV手术并采用逆行动脉灌注及EAC或TTC的患者进行了一项单中心前瞻性观察研究。进行倾向匹配分析以比较两组。主要结局是比较术后不同时间点测量的心肌肌钙蛋白T水平。80例EAC患者与37例TTC患者进行了比较。总体上未报告心肌梗死或低心排血量综合征病例。在中风、围手术期死亡率、心肌标志物释放、乳酸水平以及术后不同时间点的强心支持需求方面未记录到差异。EAC组的肌酸激酶同工酶（CK-MB）峰值水平显著更低。尽管对EAC存在担忧，但这项前瞻性研究表明，在接受右胸小切口MV手术的患者中，EAC与TTC在心肌保护方面具有等效性。
