PDF(Pubmed)
Abstract：
BACKGROUND: The evidence for using del Nido cardioplegia protocol in high-risk patients with reduced ejection fraction undergoing isolated coronary surgery is insufficient.
METHODS: The institutional database was searched for isolated coronary bypass procedures. Patients with ejection fraction < 40% were selected. Propensity matching (age, sex, infarction, number of grafts) was used to pair del Nido (Group 1) and cold blood (Group 2) cardioplegia patients. Investigation of biomarker release, changes in ejection fraction, mortality, stroke, perioperative myocardial infarction, composite endpoint (major adverse cardiac and cerebrovascular events), and other perioperative parameters was performed.
RESULTS: Matching allowed the selection of 45 patient pairs. No differences were noted at baseline. After cross-clamp release, spontaneous sinus rhythm return was observed more frequently in Group 1 (80% vs. 48.9%; P=0.003). Troponin values were similar in both groups 12 and 36 hours after surgery, as well as creatine kinase at 12 hours. A trend favored Group 1 in creatine kinase release at 36 hours (median 4.9; interquartile range 3.8-9.6 ng/mL vs. 7.3; 4.5-17.5 ng/mL; P=0.085). Perioperative mortality, rates of myocardial infarction, stroke, or major adverse cardiac and cerebrovascular events were similar. No difference in postoperative ejection fraction was noted (median 35.0%; interquartile range 32.0-38.0% vs. 35.0%; 32.0-40.0%; P=0.381). There was a trend for lower atrial fibrillation rate in Group 1 (6.7% vs. 17.8%; P=0.051).
CONCLUSIONS: The findings indicate that del Nido cardioplegia provides satisfactory protection in patients with reduced ejection fraction undergoing coronary bypass surgery. Further prospective trials are required.
METHODS: The institutional database was searched for isolated coronary bypass procedures. Patients with ejection fraction < 40% were selected. Propensity matching (age, sex, infarction, number of grafts) was used to pair del Nido (Group 1) and cold blood (Group 2) cardioplegia patients. Investigation of biomarker release, changes in ejection fraction, mortality, stroke, perioperative myocardial infarction, composite endpoint (major adverse cardiac and cerebrovascular events), and other perioperative parameters was performed.
RESULTS: Matching allowed the selection of 45 patient pairs. No differences were noted at baseline. After cross-clamp release, spontaneous sinus rhythm return was observed more frequently in Group 1 (80% vs. 48.9%; P=0.003). Troponin values were similar in both groups 12 and 36 hours after surgery, as well as creatine kinase at 12 hours. A trend favored Group 1 in creatine kinase release at 36 hours (median 4.9; interquartile range 3.8-9.6 ng/mL vs. 7.3; 4.5-17.5 ng/mL; P=0.085). Perioperative mortality, rates of myocardial infarction, stroke, or major adverse cardiac and cerebrovascular events were similar. No difference in postoperative ejection fraction was noted (median 35.0%; interquartile range 32.0-38.0% vs. 35.0%; 32.0-40.0%; P=0.381). There was a trend for lower atrial fibrillation rate in Group 1 (6.7% vs. 17.8%; P=0.051).
CONCLUSIONS: The findings indicate that del Nido cardioplegia provides satisfactory protection in patients with reduced ejection fraction undergoing coronary bypass surgery. Further prospective trials are required.
摘要：
背景：在行单纯冠状动脉手术射血分数降低的高危患者中使用delNido心脏停搏液方案的证据不足。
方法：在机构数据库中搜索单独的冠状动脉搭桥手术。选择射血分数<40%的患者。倾向匹配(年龄，性别,梗塞,移植物数量）用于配对delNido（第1组）和冷血（第2组）心脏停搏症患者。生物标志物释放的调查，射血分数的变化，死亡率,中风,围手术期心肌梗死,复合终点（主要不良心脑血管事件），和其他围手术期参数进行。
结果：匹配允许选择45对患者。在基线时没有发现差异。交叉卡箍释放后,在第1组中观察到更频繁的自发性窦性心律恢复(80%与48.9%;P=0.003)。术后12和36小时两组的肌钙蛋白值相似，以及12小时时的肌酸激酶。第1组36小时肌酸激酶释放的趋势较好（中位数4.9；四分位数范围3.8-9.6ng/mL与7.3；4.5-17.5ng/mL；P=0.085）。围手术期死亡率,心肌梗塞的发生率，中风,或主要不良心脑血管事件相似。术后射血分数无差异（中位数为35.0％；四分位距32.0-38.0％与35.0%；32.0-40.0%；P=0.381）。第1组房颤发生率有降低趋势(6.7%vs.17.8%；P=0.051）。
结论：研究结果表明，DelNido心脏停搏液对冠状动脉搭桥手术射血分数降低的患者提供了令人满意的保护。需要进一步的前瞻性试验。
方法：在机构数据库中搜索单独的冠状动脉搭桥手术。选择射血分数<40%的患者。倾向匹配(年龄，性别,梗塞,移植物数量）用于配对delNido（第1组）和冷血（第2组）心脏停搏症患者。生物标志物释放的调查，射血分数的变化，死亡率,中风,围手术期心肌梗死,复合终点（主要不良心脑血管事件），和其他围手术期参数进行。
结果：匹配允许选择45对患者。在基线时没有发现差异。交叉卡箍释放后,在第1组中观察到更频繁的自发性窦性心律恢复(80%与48.9%;P=0.003)。术后12和36小时两组的肌钙蛋白值相似，以及12小时时的肌酸激酶。第1组36小时肌酸激酶释放的趋势较好（中位数4.9；四分位数范围3.8-9.6ng/mL与7.3；4.5-17.5ng/mL；P=0.085）。围手术期死亡率,心肌梗塞的发生率，中风,或主要不良心脑血管事件相似。术后射血分数无差异（中位数为35.0％；四分位距32.0-38.0％与35.0%；32.0-40.0%；P=0.381）。第1组房颤发生率有降低趋势(6.7%vs.17.8%；P=0.051）。
结论：研究结果表明，DelNido心脏停搏液对冠状动脉搭桥手术射血分数降低的患者提供了令人满意的保护。需要进一步的前瞻性试验。
