Huang Yingshan, Zhu Xiangni, Kong Jichang, Zhang Ling, Gui Wenting, Wang Jiao, Yang Yunling, Xie Yan, Wang Dongmei, Li Xinyue, Zhou Long, Song Yi, Wang Xiaoqi
Department of Cardiopulmonary Bypass, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences/Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China.
Department of Echocardiography, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences/Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China.
Perfusion. 2025 Jul;40(5):1258-1266. doi: 10.1177/02676591241292670. Epub 2024 Oct 11.
ObjectiveThis study aimed to compare the safety and efficacy of Del Nido cardioplegia (DNC) and conventional blood cardioplegia (CBC) in combined aortic surgery.MethodsThis retrospective study involved elective patients who underwent combined aortic root surgery between September 2017 and July 2023. Patients were divided into two groups: the DNC and the CBC group. The primary outcome was high-sensitivity cardiac troponin I and creatine kinase-MB levels at the 0, 1, 2, and three postoperative days. The secondary outcomes contained postoperative left ventricular ejection fraction, return to spontaneous rhythm after aortic de-clamping, postoperative myocardial infarction, new-onset atrial fibrillation, postoperative mechanical circulatory support, mechanical ventilation duration, intensive care unit stay, postoperative hospital stay, and the reduction of left ventricle end-diastolic diameter at 3 months after surgery.Results223 patients were included and divided into the CBC ( = 111) and the DNC group ( = 112). There was no statistical difference in patients' demographics and preoperative parameters between the two groups. No in-hospital mortality. The total cardioplegia volume [35.25 (30.30,43.65) ml/kg versus 21.43 (18.42,25.62) ml/kg, < 0.001] and infusion times [2 (2,3) times versus 1 (1,2) times, < 0.001] were less and the incidence of return to spontaneous rhythm after de-clamping was higher in the DNC group [59.5% versus 83%, < 0.001]. Postoperative high-sensitivity cardiac troponin I and creatine kinase-MB levels were comparable between the two groups. DNC is related to a shorter duration of mechanical ventilation, intensive care unit stay, and hospital stay than CBC. The rate of return to spontaneous rhythm after aortic de-clamping seemed to decrease with the prolongation of aortic cross-clamping (ACC) duration, and there was no difference between the two groups when the time exceeded 120 min.ConclusionsThe safety and efficacy of using DNC were comparable to CBC in combined aortic surgery. The rate of return to spontaneous rhythm after aortic de-clamping seemed to decrease with the prolongation of ACC time. Further studies may be needed to fully elucidate the advantages of DNC in postoperative recovery and its long-term effects on patient outcomes.
目的
本研究旨在比较德尔尼多停搏液（DNC）与传统血液停搏液（CBC）在主动脉联合手术中的安全性和有效性。
方法
本回顾性研究纳入了2017年9月至2023年7月期间接受主动脉根部联合手术的择期患者。患者分为两组：DNC组和CBC组。主要结局指标为术后第0、1、2和3天的高敏心肌肌钙蛋白I和肌酸激酶-MB水平。次要结局指标包括术后左心室射血分数、主动脉夹闭解除后恢复自主心律情况、术后心肌梗死、新发房颤、术后机械循环支持、机械通气时间、重症监护病房停留时间、术后住院时间以及术后3个月左心室舒张末期直径的缩小情况。
结果
共纳入223例患者，分为CBC组（n = 111）和DNC组（n = 112）。两组患者的人口统计学和术前参数无统计学差异。无院内死亡。DNC组的总停搏液量[35.25（30.30，43.65）ml/kg vs 21.43（18.42，25.62）ml/kg，P < 0.001]和输注次数[2（2，3）次 vs 1（1，2）次，P < 0.001]更少，夹闭解除后恢复自主心律的发生率更高[59.5% vs 83%，P < 0.001]。两组术后高敏心肌肌钙蛋白I和肌酸激酶-MB水平相当。与CBC相比，DNC与更短的机械通气时间、重症监护病房停留时间和住院时间相关。主动脉夹闭解除后恢复自主心律的发生率似乎随主动脉阻断（ACC）时间的延长而降低，当时间超过120分钟时，两组之间无差异。
结论
在主动脉联合手术中，使用DNC的安全性和有效性与CBC相当。主动脉夹闭解除后恢复自主心律的发生率似乎随ACC时间的延长而降低。可能需要进一步研究以充分阐明DNC在术后恢复中的优势及其对患者结局的长期影响。
