Szalkiewicz Philipp, Emmert Maximilian Y, Heinisch Paul P, Arnold Zsuzsanna, Crailsheim Ingo, Mach Markus, Aschacher Thomas, Grabenwöger Martin, Winkler Bernhard
Karl Landsteiner Institute for Cardiac and Vascular Surgical Research, Vienna, Austria.
Deutsches Herzzentrum Berlin, Berlin, Germany.
Front Cardiovasc Med. 2022 Jul 28;9:922357. doi: 10.3389/fcvm.2022.922357. eCollection 2022.
During on-pump coronary artery bypass grafting (ONCAB), graft flushing for distal anastomoses testing also perfuses the downstream myocardium. This single-center retrospective study evaluated the impact of specific preservation solutions on myocardial protection during ONCAB.
Between July 2019 and March 2020 either DuraGraft (DG) or 0.9% Saline/Biseko (SB) was applied to 272 ONCAB. Overall, 166 patients were propensity-matched into two groups. Cardiac enzymes [high-sensitive Troponin I (hs-TnI) and creatine kinase (CK)] were evaluated 7 days post-surgery.
Post-surgery, hs-TnI values were significantly lower from 3 to 6 h (h) up to 4 days in the DG group: 3-6 h: 4,034 ng/L [IQR 1,853-8,654] vs. 5,532 ng/L [IQR 3,633-8,862], = 0.05; 12-24 h: 2,420 ng/L [IQR 1,408-5,782] vs. 4,166 [IQR 2,052-8,624], < 0.01; 2 days: 1,095 ng/L [IQR 479-2,311] vs. 1,564 ng/L [IQR 659-5,057], = 0.02 and at 4 days: 488 ng/L [IQR 232-1,061] vs. 745 ng/L [IQR 319-1,820], = 0.03. The maximum value: 4,151 ng/L [IQR 2,056-8,621] vs. 6,349 ng/L [IQR 4,061-12,664], < 0.01 and the median area under the curve (AUC): 6,146 ng/L/24 h [IQR 3,121-13,248] vs. 10,735 ng/L/24 h [IQR 4,859-21,484], = 0.02 were lower in the DG group. CK values were not significantly different between groups: maximum value 690 [IQR 417-947] vs. 631 [464-979], = 0.61 and AUC 1,986 [1,226-2,899] vs. 2,081 [1,311-3,063], = 0.37.
Repeated graft flushing with DG resulted in lower Troponin values post-surgery suggesting enhanced myocardial protection compared to SB. Additional studies are warranted to further assess the myocardial protection properties of DG.
在体外循环冠状动脉搭桥术（ONCAB）期间，用于远端吻合口测试的移植物冲洗也会灌注下游心肌。这项单中心回顾性研究评估了特定保存液对ONCAB期间心肌保护的影响。
在2019年7月至2020年3月期间，272例ONCAB患者使用了DuraGraft（DG）或0.9%生理盐水/比塞可（SB）。总体而言，166例患者根据倾向得分匹配分为两组。术后7天评估心脏酶[高敏肌钙蛋白I（hs-TnI）和肌酸激酶（CK）]。
术后，DG组术后3至6小时直至4天的hs-TnI值显著较低：3 - 6小时：4,034 ng/L[四分位间距1,853 - 8,654] 对比5,532 ng/L[四分位间距3,633 - 8,862]，P = 0.05；12 - 24小时：2,420 ng/L[四分位间距1,408 - 5,782] 对比4,166[四分位间距2,052 - 8,624]，P < 0.01；2天时：1,095 ng/L[四分位间距479 - 2,311] 对比1,564 ng/L[四分位间距659 - 5,057]，P = 0.02；4天时：488 ng/L[四分位间距232 - 1,061] 对比745 ng/L[四分位间距319 - 1,820]，P = 0.03。最大值：4,151 ng/L[四分位间距2,056 - 8,621] 对比6,349 ng/L[四分位间距4,061 - 12,664]，P < 0.01；曲线下面积中位数（AUC）：6,146 ng/L/24小时[四分位间距3,121 - 13,248] 对比10,735 ng/L/24小时[四分位间距4,859 - 21,484]，P = 0.02，DG组更低。两组间CK值无显著差异：最大值690[四分位间距417 - 947] 对比631[464 - 979]，P = 0.61；AUC 1,986[1,226 - 2,899] 对比2,081[1,311 - 3,063]，P = 0.37。
与SB相比，用DG反复冲洗移植物导致术后肌钙蛋白值更低，提示心肌保护增强。有必要进行更多研究以进一步评估DG的心肌保护特性。
