Yang Y L, Liang Y, Li X Y, Zhang L, Wang D M, Wang J, Huang Y S, Xie Y, Zhou L, Song Y, Guan Y L
Department of Extracorporeal Circulation, Fuwai Yunnan Cardiovascular Hospital, Kunming 650102, China.
Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China.
Zhonghua Yi Xue Za Zhi. 2023 Dec 26;103(48):3924-3931. doi: 10.3760/cma.j.cn112137-20230810-00196.
To explore the efficacy of myocardial protection with single-dose histidine-tryptophan-ketoglutarate (HTK) cardioplegia during aortic root operation, and the correlation between short-term clinical outcomes and duration of myocardial ischemia. The data of clinical cases undergoing myocardial protection with single-dose HTK cardioplegia during aortic root operation from January 2018 to December 2022 were retrospectively reviewed. Patients were divided into conventional HTK cardioplegia group (<3 h) and prolonged HTK cardioplegia group (≥3 h) according to duration of intraoperative myocardial ischemia. A 1∶1 propensity score matching was performed and the correlations between duration of myocardial ischemia and postoperative short-term outcomes (30-day mortality, readmission, mechanical circulation support and renal insufficiency) were analyzed. A total of 282 patients were included in the final analysis, with 210 cases in the conventional HTK cardioplegia group and 72 cases inthe prolonged HTK cardioplegia group before matching. After matching, there were 64 cases (53 males and 11 females) in the conventional HTK cardioplegia group, with a mean age of (49.4±14.2) years. The prolonged HTK cardioplegia group had 64 cases (55 males and 9 females), with a mean age of (50.5±12.3) years. Higher sensitivity troponin [12 h: 10.1 (4.6, 18.7) μg/Lvs 4.1(2.2, 8.6) μg/L, =0.002; 24 h: 7.7 (4.5, 19.0) μg/L vs 4.8 (2.2, 11.9) μg/L, =0.025] and creatine kinase isoenzyme[12 h: 46.3 (28.1, 62.4) μg/L vs 20.7(14.1, 32.9) μg/L, 0.001; 24 h: 26.3(13.4, 49.2) μg/L vs 14.5 (10.1, 33.5)μg/L, =0.011] after surgery was detected in prolonged HTK cardioplegia group. Comparisons of other primary and secondary endpoint events showed no significant differences between the two groups (all >0.05). Multivariate binary logistic regression showed that duration of myocardial ischemia had no significant effect on postoperative 30-day mortality (=1.255, 95%: 0.500-3.148, =0.629), 30-day readmission (=0.378, 95%: 0.069-2.065, =0.261) and mechanical circulation support (=0.991, 95%: 0.331-2.970, =0.998). During aortic root surgery, single-dose HTK cardioplegia may provide satisfactory myocardial protection, and there was no significant correlation between duration of myocardial ischemia and short-term clinical outcomes.
探讨主动脉根部手术中单次剂量组氨酸 - 色氨酸 - 酮戊二酸（HTK）心脏停搏液心肌保护的效果，以及心肌缺血持续时间与短期临床结局之间的相关性。回顾性分析2018年1月至2022年12月期间在主动脉根部手术中采用单次剂量HTK心脏停搏液进行心肌保护的临床病例资料。根据术中心肌缺血持续时间将患者分为传统HTK心脏停搏液组（<3小时）和延长HTK心脏停搏液组（≥3小时）。进行1∶1倾向评分匹配，并分析心肌缺血持续时间与术后短期结局（30天死亡率、再入院、机械循环支持和肾功能不全）之间的相关性。最终分析共纳入282例患者，匹配前传统HTK心脏停搏液组210例，延长HTK心脏停搏液组72例。匹配后，传统HTK心脏停搏液组64例（男53例，女11例），平均年龄（49.4±14.2）岁。延长HTK心脏停搏液组64例（男55例，女9例），平均年龄（50.5±12.3）岁。延长HTK心脏停搏液组术后检测到更高的敏感性肌钙蛋白[12小时：10.1（4.6，18.7）μg/L对4.1（2.2，8.6）μg/L，P = 0.002；24小时：7.7（4.5，19.0）μg/L对4.8（2.2，11.9）μg/L，P = 0.025]和肌酸激酶同工酶[12小时：46.3（28.1，62.4）μg/L对20.7（14.1，32.9）μg/L，P = 0.001；24小时：26.3（13.4，49.2）μg/L对14.5（10.1，33.5）μg/L，P = 0.011]。其他主要和次要终点事件的比较显示两组之间无显著差异（均P>0.05）。多因素二元逻辑回归显示，心肌缺血持续时间对术后30天死亡率（P = 1.255，95%CI：0.500 - 3.148，P = 0.629）、30天再入院率（P = 0.378，95%CI：0.069 - 2.065，P = 0.261）和机械循环支持（P = 0.991，95%CI：0.331 - 2.970，P = 0.998）无显著影响。在主动脉根部手术中，单次剂量HTK心脏停搏液可能提供满意的心肌保护，且心肌缺血持续时间与短期临床结局之间无显著相关性。
