Tunca Nuri Utkan, Yesilkaya Nihan Karakas, Karaagac Erturk, Durmaz Huseyin, Besir Yuksel, Gokalp Orhan, Iner Hasan, Yılık Levent, Gurbuz Ali
Department of Cardiovascular Surgery, Mus State Hospital, Mus, Turkey.
Department of Cardiovascular Surgery, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey.
Perfusion. 2024 Sep;39(6):1205-1212. doi: 10.1177/02676591231182587. Epub 2023 Jun 8.
Cardiac arrest with cardioplegia is the most common and reliable method of myocardial protection in cardiac surgery, but there is no definite consensus on the use of different types of cardioplegia. Two of the commonly used types of cardioplegia are Bretschneider histidine-tryptophan-ketoglutarate solution (Custodiol) and conventional blood cardioplegia. In this study, Custodiol solution and conventional blood cardioplegia used in patients with type A aortic dissection who underwent supracoronary ascending aortic replacement were aimed to be compared in terms of postoperative results.
70 patients with type A aortic dissection who underwent supracoronary ascending aortic replacement in our clinic between January 2011 - October 2020 were included. Patients were divided into two groups, blood cardioplegia group ( = 48) and Custodiol group ( = 22) and they were compared regarding preoperative, perioperative and postoperative variables.
There was no significant difference between cardiopulmonary bypass time and cross-clamp time ( = 0.17 and = 0.16, respectively). Mechanical ventilator weaning time, intensive care unit stay and hospital stay were shorter in Custodiol group ( = 0.04, = 0.03 and = 0.05, respectively). While inotropic support need was higher in the blood cardioplegia group ( = 0.001), there was no significant difference in terms of mortality, arrhythmia, neurological complications and renal complications.
Our results show that Custodiol cardioplegia solution may be superior to blood cardioplegia in reducing mechanical ventilation weaning period, intensive care and hospital stay, and reducing the use of inotropic agents in patients with type A aortic dissection undergoing supracoronary ascending aorta replacement.
心脏停搏加心脏麻痹是心脏手术中最常用且可靠的心肌保护方法，但对于不同类型心脏麻痹的使用尚无明确共识。两种常用的心脏麻痹类型是布雷施奈德组氨酸 - 色氨酸 - 酮戊二酸溶液（Custodiol）和传统血液心脏麻痹。本研究旨在比较Custodiol溶液和传统血液心脏麻痹在接受升主动脉冠状动脉上置换术的A型主动脉夹层患者术后结果方面的差异。
纳入2011年1月至2020年10月在我院接受升主动脉冠状动脉上置换术的70例A型主动脉夹层患者。患者分为两组，血液心脏麻痹组（n = 48）和Custodiol组（n = 22），并对术前、围手术期和术后变量进行比较。
体外循环时间和主动脉阻断时间之间无显著差异（分别为P = 0.17和P = 0.16）。Custodiol组的机械通气脱机时间、重症监护病房停留时间和住院时间较短（分别为P = 0.04、P = 0.03和P = 0.05）。虽然血液心脏麻痹组对血管活性药物支持的需求更高（P = 0.001），但在死亡率、心律失常、神经并发症和肾脏并发症方面无显著差异。
我们的结果表明，在接受升主动脉冠状动脉上置换术的A型主动脉夹层患者中，Custodiol心脏麻痹溶液在缩短机械通气脱机期、重症监护和住院时间以及减少血管活性药物使用方面可能优于血液心脏麻痹。
