Chitwood W R, Wixon C L, Norton T O, Lust R M
Department of Surgery, East Carolina University School of Medicine, Greenville, North Carolina 27858, USA.
Ann Thorac Surg. 1995 Sep;60(3):815-8. doi: 10.1016/0003-4975(95)00231-9.
Increasingly complex cardiac procedures demand optimal myocardial protective techniques during the requisite interval of aortic cross-clamping. For complex procedures in which prolonged cross-clamp times are anticipated, we favor combined antegrade and retrograde cold blood cardioplegia. Advantages include rapid arrest, uniform distribution, and an uninterrupted operation.
We retrospectively evaluated the cases of 194 consecutive patients who underwent complex cardiovascular procedures between January 1988 and October 1994. Procedures performed included valve repair and coronary artery bypass grafting (23.7%), valve replacement and coronary artery bypass grafting (19.1%), complex aortic arch and valve procedures (16.6%), valve repair only (16.5%), reoperative valve (9.8%), and multiple-valve replacements (9.3%). Cardioplegic arrest times averaged 113 +/- 38.5 minutes (range, 52 to 292 minutes).
Postoperative left and right ventricular function was evaluated using transesophageal echocardiography. The echocardiograms revealed a 3.1% incidence of new left ventricular dysfunction and no case of right ventricular dysfunction. Of the patients evaluated, 75.7% required little (< 3 micrograms.kg-1.min-1 of dopamine hydrochloride) or no inotropic support postoperatively. The 30-day mortality rate was 3.1%, and no death was due to cardiac failure.
We conclude that myocardial protection using a combined antegrade and retrograde cardioplegia technique permits excellent myocardial protection during complex cardiovascular procedures requiring long arrest times.
日益复杂的心脏手术需要在主动脉阻断的必要时间段内采用最佳的心肌保护技术。对于预计需要延长阻断时间的复杂手术，我们倾向于采用顺行和逆行冷血心脏停搏联合技术。其优点包括快速停搏、均匀分布以及手术不间断。
我们回顾性评估了1988年1月至1994年10月期间连续接受复杂心血管手术的194例患者的病例。所进行的手术包括瓣膜修复和冠状动脉搭桥术（23.7%）、瓣膜置换和冠状动脉搭桥术（19.1%）、复杂主动脉弓和瓣膜手术（16.6%）、仅瓣膜修复（16.5%）、再次手术瓣膜（9.8%）以及多瓣膜置换（9.3%）。心脏停搏时间平均为113±38.5分钟（范围为52至292分钟）。
使用经食管超声心动图评估术后左心室和右心室功能。超声心动图显示新发左心室功能障碍的发生率为3.1%，无右心室功能障碍病例。在接受评估的患者中，75.7%术后几乎不需要（<3微克·千克⁻¹·分钟⁻¹的盐酸多巴胺）或不需要强心支持。30天死亡率为3.1%，无死亡因心力衰竭所致。
我们得出结论，在需要长时间停搏的复杂心血管手术中，采用顺行和逆行心脏停搏联合技术进行心肌保护可实现出色的心肌保护。
