Willekes Holliann, Parker Jessica, Fanning Justin, Leung Stephane, Spurlock David, Murphy Edward, Boeve Theodore, Leacche Marzia, Willekes Charles, Timek Tomasz
Michigan State University College of Human Medicine, Grand Rapids, Michigan.
Office of Research, Spectrum Health, Grand Rapids, Michigan.
Semin Thorac Cardiovasc Surg. 2023 Spring;35(1):33-41. doi: 10.1053/j.semtcvs.2021.10.008. Epub 2021 Oct 28.
Del Nido cardioplegia offers equivalent myocardial protection and clinical outcomes to blood cardioplegia in adult isolated CABG and valve patients, but the safety and efficacy of del Nido in complex cases with prolonged aortic cross-clamp times is still unknown. 443 patients at our center underwent replacement of the ascending aorta using either del Nido (n = 182) or blood (n = 261) cardioplegia. Two surgeons used del Nido exclusively and 6 used blood exclusively over the study period. Propensity matching of preoperative characteristics yielded 172 well matched pairs. Emergency and reoperative cases were included. Clinical data were extracted from our local database. Troponin levels were drawn at 12 hours postop in all patients. Rates of perioperative mortality (4.7% vs 5.2%), stroke (5.8% vs 7.0%), renal failure (11.6% vs 12.2%), atrial fibrillation (36.0% vs 31.4%), intra-aortic balloon pump insertion (2.3% vs1.2%), and extra corporeal membrane oxygenation use (4.7% vs 4.1%) did not differ between blood and del Nido groups. Postop Troponin T levels were 0.50[0.35, 0.86] ng/mL and 0.40[0.20, 0.70] ng/mL for blood and del Nido, respectively (P < 0.0001). Postop echocardiography was available in 333 of 344 (96.8%) patients, and there was no difference in change in EF from pre- to postop between blood 0.0[-6.0, 5.0]% and del Nido 0.0 [-6.0, 3.5]% (P = 0.201). Subgroup analysis of patients with aortic cross-clamp time greater than 180 minutes (blood = 77, del Nido = 27) revealed no difference in troponins, ejection fraction, or clinical outcomes. Five-year survival was 85.9[76.8, 91.7]% and 79.8[71.2, 86.1]% for blood and del Nido, respectively (P = 0.151). In ascending aortic surgery with prolonged operative times, no differences were observed in myocardial protection or clinical outcomes with the use of del Nido cardioplegia compared to blood cardioplegia.
在成人孤立性冠状动脉旁路移植术（CABG）和瓣膜手术患者中，Del Nido心脏停搏液在心肌保护和临床结局方面与血液心脏停搏液相当，但在主动脉阻断时间延长的复杂病例中，Del Nido的安全性和有效性仍不明确。我们中心的443例患者在升主动脉置换术中使用了Del Nido心脏停搏液（n = 182）或血液心脏停搏液（n = 261）。在研究期间，两名外科医生仅使用Del Nido心脏停搏液，6名外科医生仅使用血液心脏停搏液。对术前特征进行倾向匹配后得到172对匹配良好的病例。纳入了急诊和再次手术病例。临床数据从我们当地的数据库中提取。所有患者在术后12小时检测肌钙蛋白水平。血液心脏停搏液组和Del Nido心脏停搏液组在围手术期死亡率（4.7% 对5.2%）、中风（5.8% 对7.0%）、肾衰竭（11.6% 对12.2%）、房颤（36.0% 对31.4%）、主动脉内球囊泵置入率（2.3% 对1.2%）和体外膜肺氧合使用率（4.7% 对4.1%）方面没有差异。血液心脏停搏液组和Del Nido心脏停搏液组术后肌钙蛋白T水平分别为0.50[0.35, 0.86] ng/mL和0.40[0.20, 0.70] ng/mL（P < 0.0001）。344例患者中有333例（96.8%）术后进行了超声心动图检查，血液心脏停搏液组术后射血分数（EF）较术前变化为0.0[-6.0, 5.0]%，Del Nido心脏停搏液组为0.0 [-6.0, 3.5]%，两者之间无差异（P = 0.201）。对主动脉阻断时间大于180分钟的患者进行亚组分析（血液心脏停搏液组 = 77例，Del Nido心脏停搏液组 = 27例），结果显示肌钙蛋白、射血分数或临床结局方面没有差异。血液心脏停搏液组和Del Nido心脏停搏液组的5年生存率分别为85.9[76.8, 91.7]%和79.8[71.2, 86.1]%（P = 0.151）。在手术时间延长的升主动脉手术中，与血液心脏停搏液相比，使用Del Nido心脏停搏液在心肌保护或临床结局方面未观察到差异。
