Szpytma Malgorzata, Gimpel Damian, Ross Jordan, Newland Richard F, Crouch Gareth, Rice Gregory D, Bennetts Jayme S, Baker Robert A
Cardiothoracic Surgical Unit, Division of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
Perfusion Service, Cardiothoracic Surgical Unit, Division of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia - College of Medicine and Public Health, Flinders University.
J Extra Corpor Technol. 2024 Dec;56(4):149-158. doi: 10.1051/ject/2024029. Epub 2024 Dec 20.
The utility and uptake of Del Nido cardioplegia in adult cardiac surgery is rapidly increasing. Cases with prolonged aortic cross-clamp times necessitate multi-dosing however an understanding of safe ischaemic times and definitive guidelines in this domain are lacking. Therefore, this study aimed to assess the safety and efficacy of our DNC strategy by comparing post-operative troponin profiles and clinical outcomes between Del Nido and hyperkalaemic cardioplegia for cases with aortic cross-clamp times of greater than 90 min.
A single-centre, retrospective cohort study at Flinders Medical Centre and Flinders Private Hospital of patients undergoing composite cardiac surgery with a cross-clamp time longer than 90 min. Data was prospectively collected from the Flinders Cardiac Surgery Registry from June 2014 to December 2022. A propensity-matched (1:1) analysis was performed comparing patients receiving Del Nido cardioplegia (n = 194) to those receiving hyperkalemic blood cardioplegia (n = 194). The primary outcome was the postoperative troponin release profile with clinical events reported as secondary outcomes.
There was no difference in the peak or median troponin at 6, 12 and 72 h nor the number of patients with positive troponin profiles postoperatively between cohorts. There was no difference in clinical outcomes between groups with aortic cross-clamp times of 90 min which remained true in sensitivity analysis extending out to 120 min. The Del Nido cohort received less cardioplegia volume (p < 0.001) and were more likely to return to spontaneous rhythm (p < 0.002).
Del Nido cardioplegia for anticipated aortic cross-clamp times of greater than 90 min provided equivocal post-operative troponin profiles and clinical outcomes compared to multidose hyperkalemic blood cardioplegia.
德尔尼多停搏液在成人心脏手术中的应用和接受程度正在迅速增加。主动脉阻断时间延长的病例需要多次给药，然而，目前缺乏对该领域安全缺血时间的了解和明确的指南。因此，本研究旨在通过比较主动脉阻断时间超过90分钟的病例中，德尔尼多停搏液和高钾停搏液术后肌钙蛋白水平及临床结局，评估我们的德尔尼多停搏液策略的安全性和有效性。
在弗林德斯医疗中心和弗林德斯私立医院进行的一项单中心回顾性队列研究，研究对象为接受心脏复合手术且主动脉阻断时间超过90分钟的患者。数据于2014年6月至2022年12月从弗林德斯心脏手术登记处前瞻性收集。进行倾向匹配（1:1）分析，比较接受德尔尼多停搏液的患者（n = 194）和接受高钾血性心脏停搏液的患者（n = 194）。主要结局是术后肌钙蛋白释放情况，临床事件作为次要结局报告。
两组在术后6、12和72小时的肌钙蛋白峰值或中位数，以及术后肌钙蛋白阳性患者数量上均无差异。主动脉阻断时间为90分钟的组间临床结局无差异，在长达120分钟的敏感性分析中也是如此。德尔尼多停搏液组接受的停搏液量较少（p < 0.001），且更有可能恢复自主心律（p < 0.002）。
与多次高钾血性心脏停搏液相比，预期主动脉阻断时间超过90分钟时使用德尔尼多停搏液，术后肌钙蛋白水平和临床结局相当。
