Comparison of the efficacy between Del Nido cardioplegia and HTK cardioplegia in Stanford type A aortic dissection patients undergoing open-heart surgery

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022;47(9):1235-1243. doi: 10.11817/j.issn.1672-7347.2022.220217.
[Article in English, Chinese]

Abstract

Objectives: Acute Stanford type A aortic dissection is an extremely dangerous and life-threatening cardiovascular disease, usually treated with extracorporeal circulation heart surgery. Histidine-tryptophan-ketoglutarate (HTK) cardioplegia is a protective intracellular myocardial fluid that has been used extensively in different types of extracorporeal circulation surgeries. Del Nido cardioplegia is an extracellular myocardial protection fluid, which was first used in pediatric heart surgery and has been gradually used in a variety of pediatric and adult heart procedures. This study aims to compare the myocardial protection effect between Del Nido and HTK in patients undergoing extracorporeal circulation heart surgery for acute Stanford type A dissection and its impact on patients' prognosis by analyzing selected parameters and clinical manifestations at different time points.

Methods: Clinical data were collected from 431 patients with acute Stanford type A dissection who were diagnosed and underwent surgery between January 1, 2018 and December 31, 2020 at Xiangya Hospital, Central South University. After excluding some of the data based on exclusion criteria, patients were divided into a HTK group and a Del Nido (DN) group based on type of intraoperative cardioplegia. Propensity score-matching was performed subsequently using the the R statistical software to determine the DN group (n=40) and HTK group (n=41). The matching factors were age, sex, hypertension, cardiopulmonary bypass time, and aortic occlusion time. Perioperative data, postoperative complications, blood gas data, and myocardial injury data were collected from the patients, and SPSS 26.0 was used to analyze the data of each group.

Results: The DN group had a higher rate of spontaneous cardioversion (41.5% vs 15.0%, P=0.005) and a lower postoperative hospital stay [10.0(8.0,14.0) d vs 13.0(11.0,19.0) d, P<0.05] compared to the HTK group. In terms of changes in blood gas analysis, immediate sodium and potassium concentrations were significantly higher in the DN group than that in the HTK group (both P<0.05). There was no significant difference in myocardial injury indexes between the two groups at different time points (all P>0.05). In terms of postoperative complications, the cardiac complications in DN group were much lower than those in the HTK Group (0 vs 12.5%, P=0.026).

Conclusions: Del Nido cardioplegia has similar myocardial protective effects as HTK cardioplegia used in Stanford type A aortic dissection, with a higher rate of cardiac recurrence and fewer cardiac complications. Del Nido cardioplegia should play an important role in future application for acute Stanford type A aortic dissection, but our findings need to be further validated in a large sample of prospective clinical studies.

目的: 急性Stanford A型主动脉夹层是一种危及患者生命的心血管疾病,一般采用体外循环下心脏外科手术治疗,手术难度大、时间长,心肌保护在手术过程中尤为重要。组氨酸-色氨酸-酮戊二酸(histidine-tryptophan-ketoglutarate,HTK)停搏液是一种细胞内液型心肌保护液,已广泛运用于各类心脏停搏下体外循环手术。Del Nido停搏液是一种细胞外液型心肌保护液,最初用于小儿心脏外科手术,后逐渐应用于各式小儿及成人心脏外科手术中。本研究通过分析接受体外循环下心脏外科手术的急性Standord A型主动脉夹层患者不同时间点的部分检验指标及临床表现,旨在比较Del Nido停搏液和HTK停搏液应用于Stanford A型主动脉夹层手术中的心肌保护效果和对患者预后的影响。方法: 收集2018年1月1日至2020年12月31日期间在中南大学湘雅医院确诊并进行手术的431例急性Standord A型主动脉夹层患者的临床资料,按照排除标准剔除部分资料后,依据患者术中使用的停搏液分为HTK组和Del Nido(DN)组,使用R统计软件包对2组患者的部分特征进行倾向性评分匹配,最终共纳入81例患者,其中DN组40例和HTK组41例。两组患者的年龄、性别、高血压、体外循环时间、主动脉阻断时间差异均无统计学意义(均P>0.05)。比较两组患者的围手术期资料、术后并发症资料以及不同时间点时的血气分析指标与心肌损伤指标。结果: DN组相较于HTK组有更高的心脏自动复跳率(41.5% vs 15.0%,P=0.005)以及更少的术后住院天数[10.0(8.0, 14.0) vs 13.0(11.0, 9.0),P<0.05]。在血气分析变化方面,DN组在体外循环开始后即刻钠离子和钾离子浓度均显著高于HTK组(均P<0.05)。不同时间点心肌损伤指标在两组间差异无统计学意义(均P>0.05)。在术后并发症方面,DN组的心脏并发症发生率远低于HTK组(0 vs 12.5% ,P=0.026)。结论: Del Nido停搏液应用于Stanford A型主动脉夹层时与HTK停搏液有相似的心肌保护效果,且具有更高的心脏自动复跳率和更低的心脏并发症发生率。Del Nido心脏停搏液在未来的急性Stanford A型主动脉夹层手术中具有一定的应用前景,但本研究结论需大样本临床前瞻性研究进一步验证。.

Keywords: Del Nido cardioplegia; HTK cardioplegia; Stanfordtype type A; aorticdissection; myocardial protection.

MeSH terms

  • Adult
  • Aneurysm, Dissecting* / surgery
  • Cardiac Surgical Procedures*
  • Child
  • Heart Arrest, Induced
  • Heart Injuries*
  • Histidine
  • Humans
  • Postoperative Complications
  • Prospective Studies
  • Tryptophan

Substances

  • Histidine
  • Tryptophan