Minimal invaziv aort kapak replasmanı yapılan erişkin hastalarda del Nido kardiyopleji solüsyonu, kan kardiyoplejisi ve St. Thomas kardiyopleji solüsyonunun metabolik etkilerinin karşılaştırılması

Yıl 2018, , 260 - 265, 28.12.2018

Ayşe Lafçı , Derya Gokcinar , Ali Baran Budak Osman Dag Kevin Mccusker Serdar Günaydin

https://doi.org/10.18663/tjcl.467548

Cited By: 1

Öz

Amaç:
Kardiyopulmoner baypas (CPBP) sırasında
kardiyak arrest, miyokardiyal koruma için kardiyoplejik solüsyonlar kullanılarak
sağlanır. Kardiyopleji solüsyonlarının sistemik biyokimyasal etkileri hakkında
sınırlı veri bulunmaktadır. Bu çalışma, del Nido kardiyopleji, kan kardiyopleji
ve St. Thomas kardiyopleji solüsyonlarının biyokimyasal etkilerini
karşılaştırmayı amaçlamıştır.

Gereç
ve Yöntemler: Bu retrospektif çalışma, 1 Ağustos
2017 – 31 Temmuz 2018 tarihleri arasında minimal invaziv aort kapak replasmanı
yapılan hastaları içermektedir. Etik kurul onayı alındıktan sonra hastaların
tıbbi kayıtları gözden geçirildi. Hastalar ameliyat sırasında kullanılan
kardiyoplejiye göre 3 gruba ayrıldı: del Nido cardioplegia grubu (dNC grubu);
kan kardiyopleji grubu (BC grubu); St Thomas kardiyopleji grubu (STC grubu).
Perioperatif klinik sonuçlar ve laboratuvar bulguları gruplar arasında karşılaştırıldı.

Bulgular:
Çalışmaya minimal invaziv aort kapak replasmanı yapılan 26 hasta dahil edildi.
DNC grubundaki hastalar, diğer 2 gruptan daha az inotropik ajan gerektirdi,
ancak fark anlamlı değildi (P = 0.844). Preoperatif  ve postoperatif troponin t düzeyi değişikliklerinde
gruplar arasında anlamlı fark yoktu (P = 0.148). Arteryel glukoz ve insülin
düzeylerindeki fark 3 grubun hepsinde benzerdi (sırasıyla P = 0.372 ve P =
0.258). Tiroid, karaciğer ve böbrek fonksiyonları da 3 grupta benzerdi.

Sonuç:
dNC solüsyonu, minimal invaziv aort kapak replasmanı ameliyatında miyokardiyal
koruma ve biyokimyasal parametreler açısından kan kardiyopleji ve St. Thomas kardiyopleji solüsyonlarına
güvenli bir alternatiftir.

Anahtar Kelimeler

Minimal invaziv, aort kapak replasmanı, del Nido kardiyopleji solüsyonu, kan kardiyopleji solüsyonu, St. Thomas kardiyopleji solüsyonu

Comparison of metabolic effects of del Nido cardioplegia, blood cardioplegia, and St. Thomas cardioplegia solutions in adult patients undergoing isolated minimally invasive aortic valve replacement surgery

Öz

Aim: Cardiac arrest
during cardiopulmonary bypass (CPBP) is achieved using cardioplegia solutions
for myocardial protection. There are limited data about the systemic
biochemical effects of cardioplegia solutions. This study aimed to compare the
biochemical effects of del Nido cardioplegia, blood cardioplegia, and St.
Thomas cardioplegia solutions.

Material and Methods: This
retrospective study included patients that underwent isolated Aortic valve
replacement between 1 August 2017 and 31 July 2018. The medical records of patients reviewed after ethical approval of the
protocol. Patients were divided into 3 groups
according to the cardioplegia solution used during surgery, as follows: the del
Nido cardioplegia group (dNC group); the blood cardioplegia group (BC group);
the St. Thomas cardioplegia group (STC group). Perioperative clinical outcomes
and laboratory findings were compared between groups.

Results: The
study included 26 patients that
underwent minimally invasive aortic valve replacement. Fewer patients in the
dNC group required inotropic agents than in the other 2 groups, but the
difference was not significant (P = 0.844). There wasn’t a significant difference between the groups in the change
in the troponin t level from the preoperative to postoperative period (P =
0.148). The difference in the arterial glucose and insulin levels was similar
in all 3 groups (P = 0.372 and P = 0.258, respectively). Thyroid, liver, and
renal function were also similar in all 3 groups.

Conclusion: dNC
solution is a safe alternative to BC and STC solutions during isolated minimally invasive aortic valve
replacement surgery, in terms of myocardial protection and biochemical
parameters. 

Anahtar Kelimeler

Minimally invasive, aortic valve replacement, del Nido cardioplegia solution, blood cardioplegia solution, St. Thomas cardioplegia solution

Kaynakça

• 1) Mishra P, Jadhav RB, Mohapatra CKR et al. Comparison of del Nido cardioplegia and St. Thomas Hospital solution – two types of cardioplegia in adult cardiac surgery. Kardiochir Torakochirurgia Pol 2016; 13: 295–99.
• 2) Pourmoghadam KK, Ruzmetov M, O'Brien MC et al. Comparing del Nido and Conventional Cardioplegia in Infants and Neonates in Congenital Heart Surgery. Ann Thorac Surg 2017; 103: 1550-56
• 3) Faber MM, Noordzij PG, Hennink S et al. Comparison of Warm Blood Cardioplegia Delivery With or Without the Use of a Roller Pump. J Extra Corpor Technol 2015; 47: 209-16.
• 4) Matte GS, del Nido PJ. History and Use of del Nido Cardioplegia Solution at Boston Children’s Hospital. J Extra Corpor Technol 2012; 44: 98-103.
• 5) O'Blenes SB, Friesen CH, Ali A, Howlett S. Protecting the aged heart during cardiac surgery: the potential benefits of del Nido cardioplegia. J Thorac Cardiovasc Surg 2011; 141: 762-70.
• 6) Sorabella RA, Akashi H, Yerebakan H et al. Myocardial protection using del nido cardioplegia solution in adult reoperative aortic valve surgery. J Card Surg 2014; 29: 445-49.
• 7) Kim K, Ball C, Grady P, Mick S. Use of del Nido Cardioplegia for Adult Cardiac Surgery at the Cleveland Clinic: Perfusion Implications. J Extra Corpor Technol 2014; 46: 317-23.
• 8) Yerebakan H, Sorabella RA, Najjar M et al. Del Nido Cardioplegia can be safely administered in high-risk surgery after acute myocardial infarction: a propensity matched comparison. J Cardiothorac Surg 2014; 9: 141
• 9) Kim JS, Jeong JH, Moon SJ, Ahn H, Hwang HY. Sufficient myocardial protection of del Nido cardioplegia regardless of ventricular mass and myocardial ischemic time in adult cardiac surgical patients. J Thorac Dis 2016; 8: 2004-10.
• 10) Mick SL, Robich MP, Houghtaling PL et al. del Nido versus Buckberg cardioplegia in adult isolated valve surgery. J Thorac Cardiovasc Surg 2015; 149: 626-34.
• 11) Calafiore AM, Teodori G, Mezzetti A et al. Intermittent antegrade warm blood cardioplegia. Ann Thorac Surg 1995; 59: 398-402.
• 12) Vistarini N, Laliberté E, Beauchamp P et al. Del Nido cardioplegia in the setting of minimally invasive aortic valve surgery. Perfusion 2017; 32: 112-17.
• 13) Charette K, Gerrah R, Quaegebeur J et al. Single dose myocardial protection technique utilizing del Nido cardioplegia solution during congenital heart surgery procedures. Perfusion 2012; 27: 98-103.
• 14) Ririe DG, Butterworth JF, Hines M, Hammon JW Jr, Zaloga GP. Effects of cardiopulmonary bypass and deep hypothermic circulatory arrest on the thyroid axis during and after repair of congenital heart defects: preservation by deep hypothermia? Anesth Analg 1998; 87: 543-48.
• 15) Yuan SM. A generalized consideration of myocardial preservation with cold crystalloid versus warm blood cardioplegia in heart valve replacement. Kaohsiung J Med Sci 1998; 14: 266-73.
• 16) Matata BM, Scawn N, Morgan M et al. A Single-Center Randomized Trial of Intraoperative Zero-Balanced Ultrafiltration During Cardiopulmonary Bypass for Patients With Impaired Kidney Function Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2015; 29: 1236-47.
• 17) Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol 2006; 1: 19-32.