Chung Megan M, Erwin William C, Ning Yuming, Zhao Yanling, Chan Christine, D'Angelo Alex, Kossar Alexander, Spellman Jessica, Kurlansky Paul, Takayama Hiroo
Division of Cardiothoracic Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY.
Center for Innovation and Outcomes Research, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY.
JTCVS Open. 2022 Jun;10:39-61. doi: 10.1016/j.xjon.2022.04.028. Epub 2022 Apr 23.
While del Nido (DN) cardioplegia is increasingly used in cardiac surgery, knowledge is limited in its safety profile for operations with prolonged crossclamp time (CCT). We have introduced a unique redosing strategy for aortic surgery: all operations use DN with a 1000-mL initiation dose (750 mL antegrade, 250 mL retrograde) composed of 1:4 blood:DN crystalloid. At 90 minutes CCT and every 30 minutes thereafter, a 250-mL dose was introduced retrograde in a 4:1 ("reverse") ratio. Additionally, at 90 minutes CCT and every 90 minutes thereafter, a reverse ratio dose of approximately 100 to 400 mL was introduced via the right coronary artery. Here, we analyze the outcomes of our unique redosing strategy used.
In total, 440 patients underwent aortic surgery between January 2015 and March 2021 under a single surgeon and received DN. Our primary end points were change in left ventricular ejection fraction (LVEF) and right ventricular systolic function based on echocardiography. Multivariable linear regression was used to analyze the relationship between CCT and outcomes.
The median was 61 years old (interquartile range, 51-69), and 23% were female. Indication was aneurysm in 65% and dissection in 24%. Median preoperative LVEF was 60% (55%-62%). Median CCT and cardiopulmonary bypass times were 135 minutes (93-165 minutes) and 181 minutes (142-218 minutes), respectively. In-hospital mortality occurred in 3%. Multivariable linear regression showed CCT was not associated with change in LVEF or change in right ventricular systolic function.
Our unique method of redosing DN cardioplegia appears to provide safe and effective myocardial protection for aortic surgery.
虽然德尔尼多（DN）心脏停搏液在心脏手术中的应用越来越广泛，但对于长时间主动脉阻断时间（CCT）手术的安全性了解有限。我们为主动脉手术引入了一种独特的再给药策略：所有手术均使用DN，起始剂量为1000毫升（顺行750毫升，逆行250毫升），由1:4的血液:DN晶体液组成。在CCT为90分钟时及之后每30分钟，以4:1（“反向”）比例逆行注入250毫升剂量。此外，在CCT为90分钟时及之后每90分钟，通过右冠状动脉注入约100至400毫升的反向比例剂量。在此，我们分析所采用的独特再给药策略的结果。
2015年1月至2021年3月期间，共有440例患者在单一外科医生操作下接受主动脉手术并使用了DN。我们的主要终点是基于超声心动图的左心室射血分数（LVEF）和右心室收缩功能的变化。采用多变量线性回归分析CCT与结果之间的关系。
患者年龄中位数为61岁（四分位间距为51 - 69岁），23%为女性。65%的手术指征为动脉瘤，24%为夹层。术前LVEF中位数为60%（55% - 62%）。CCT和体外循环时间中位数分别为135分钟（93 - 165分钟）和181分钟（142 - 218分钟）。院内死亡率为3%。多变量线性回归显示，CCT与LVEF变化或右心室收缩功能变化无关。
我们独特的DN心脏停搏液再给药方法似乎为主动脉手术提供了安全有效的心肌保护。
