Bel A, Aznag H, Faris B, Menasché P
Department of Cardiovascular Surgery, Hôpital Lariboisière, Paris, France.
Eur J Cardiothorac Surg. 1997 Jun;11(6):1118-23; discussion 1124. doi: 10.1016/s1010-7940(97)01220-7.
Despite overall good clinical results, cardiac surgery in high risk patients, such as those with poor left ventricular function or heavily hypertrophied myocardium, is still challenging. This study was designed to assess the efficacy of warm blood cardioplegia (WBC) in these two subgroups of patients.
Fifty-two patients, with an ejection fraction less than 50%, who underwent surgical revascularization, and 36 patients, with marked left ventricular hypertrophy (LVH), who were operated on for aortic valve replacement (AVR), were consecutively studied. All of them received continuous retrograde 'warm' blood cardioplegia. Results were assessed on clinical outcomes and compared with those predicted from a risk-stratifying index which has been previously validated in a large multicenter population-based study (Ontario score).
For cardiac revascularization, the rates of overall hospital mortality, Q-wave infarctions and inotropic use were respectively 5.8%, 9.6% and 21.1%, comparing favorably with those of the Ontario Group. For aortic valve replacement, the incidence of hospital mortality and Q-wave infarction was 2.8%.
By virtue of the study design, these data cannot conclusively establish the superiority of warm blood cardioplegia over other methods of myocardial protection. However, they support the safety of this technique, and suggest that these subgroups of high risk patients might represent the elective indication for aerobic arrest.
尽管心脏手术总体临床效果良好，但对于高危患者，如左心室功能不佳或心肌严重肥厚的患者，心脏手术仍具有挑战性。本研究旨在评估温血心脏停搏液（WBC）在这两类患者亚组中的疗效。
连续研究了52例接受外科血运重建且射血分数低于50%的患者，以及36例因主动脉瓣置换术（AVR）而接受手术的左心室显著肥厚（LVH）患者。他们均接受持续逆行“温”血心脏停搏液治疗。根据临床结果评估疗效，并与先前在一项大型多中心人群研究（安大略评分）中验证的风险分层指数预测的结果进行比较。
对于心脏血运重建，总体医院死亡率、Q波梗死发生率和使用正性肌力药物的比例分别为5.8%、9.6%和21.1%，优于安大略组。对于主动脉瓣置换术，医院死亡率和Q波梗死的发生率为2.8%。
基于本研究设计，这些数据不能确凿地证明温血心脏停搏液优于其他心肌保护方法。然而，它们支持了该技术的安全性，并表明这些高危患者亚组可能是有氧停搏的选择性适应证。
