Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Braz J Cardiovasc Surg. 2023 Oct 6;38(6):e20220447. doi: 10.21470/1678-9741-2022-0447.
This study evaluated myocardial protection and clinical outcomes when using lactated Ringer's solution as the base solution for del Nido cardioplegia compared with histidine-tryptophan-ketoglutarate (HTK) solution in valvular surgery.
From January 2017 to May 2018, 71 adult patients who underwent valvular surgery with del Nido cardioplegia (n=37) or HTK cardioplegia (n=34) were retrospectively analyzed.
Patients' characteristics were comparable between groups. Postoperative peak troponin T levels were similar. The del Nido group had a decreased incidence of ventricular fibrillation after aortic cross-clamp removal (13.51 vs. 55.88%; P<0.001), lower total volume of cardioplegia administered (1,000 [1,000, 1,250] vs. 1,800 [1,500, 2,000] mL; P<0.001), shorter hospital stay (6 [5, 8] vs. 7 [6, 10] days; P=0.03), and less postoperative red cell transfusion (34.29 vs. 61.11%; P=0.024). There is no difference in aortic cross-clamping time, postoperative change in left ventricular ejection fraction, intensive care unit stay, duration of inotropic support, new onset of atrial fibrillation, in-hospital mortality, complications, and three-year overall survival rate.
Lactated Ringer's-based del Nido cardioplegia can be safely used for valvular surgery with acceptable clinical outcomes compared to HTK cardioplegia.
本研究评估了在瓣膜手术中，与使用Histidine-Tryptophan-Ketoglutarate（HTK）溶液相比，使用乳酸林格氏液作为Del Nido 心脏停搏液基础溶液时的心肌保护和临床结果。
从 2017 年 1 月至 2018 年 5 月，回顾性分析了 71 例接受 Del Nido 心脏停搏液（n=37）或 HTK 心脏停搏液（n=34）行瓣膜手术的成年患者。
两组患者的特征无差异。术后肌钙蛋白 T 峰值相似。主动脉阻断后去甲肾上腺素组室颤发生率降低（13.51%比 55.88%；P<0.001），心脏停搏液总用量减少（1000[1000，1250]比 1800[1500，2000]mL；P<0.001），住院时间缩短（6[5，8]比 7[6，10]天；P=0.03），术后红细胞输注减少（34.29%比 61.11%；P=0.024）。两组主动脉阻断时间、术后左心室射血分数变化、重症监护病房停留时间、正性肌力支持时间、新发心房颤动、院内死亡率、并发症和 3 年总生存率无差异。
与 HTK 心脏停搏液相比，基于乳酸林格氏液的 Del Nido 心脏停搏液可安全用于瓣膜手术，具有可接受的临床结果。
