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Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis

BACKGROUND: Hypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic stenosis. METHODS: This retrospective study included 225 consecutive patients...

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Autores principales: Lee, Jung Hee, Jeong, Dong Seop, Sung, Kiick, Kim, Wook Sung, Lee, Young Tak, Park, Pyo Won
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society for Thoracic and Cardiovascular Surgery 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463236/
https://www.ncbi.nlm.nih.gov/pubmed/26078922
http://dx.doi.org/10.5090/kjtcs.2015.48.3.164
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author Lee, Jung Hee
Jeong, Dong Seop
Sung, Kiick
Kim, Wook Sung
Lee, Young Tak
Park, Pyo Won
author_facet Lee, Jung Hee
Jeong, Dong Seop
Sung, Kiick
Kim, Wook Sung
Lee, Young Tak
Park, Pyo Won
author_sort Lee, Jung Hee
collection PubMed
description BACKGROUND: Hypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic stenosis. METHODS: This retrospective study included 225 consecutive patients (mean age, 65±10 years; 123 males) with severe aortic stenosis who underwent aortic valve replacement. Patients were excluded if they had coronary artery disease, an ejection fraction <50%, more than mild aortic regurgitation, or endocarditis. The patients were divided into three groups: group A, which was treated with antegrade and retrograde cold blood cardioplegia; group B, which was treated with antegrade crystalloid cardioplegia using histidine-tryptophan-ketoglutarate (HTK) solution; and group C, treated with retrograde cold blood cardioplegia. RESULTS: Group A contained 70 patients (31.1%), group B contained 74 patients (32.9%), and group C contained 81 patients (36%). The three groups showed significant differences with regard to the proportion of patients with a New York Heart Association functional classification ≥III (p=0.035), N-terminal pro-brain natriuretic peptide levels (p=0.042), ejection fraction (p=0.035), left ventricular dimensions (p<0.001), left ventricular mass index (p<0.001), and right ventricular systolic pressure (p<0.001). Differences in cardiopulmonary bypass time (p=0.532) and aortic cross-clamp time (p=0.48) among the three groups were not statistically significant. During postoperative recovery, no significant differences were found regarding the use of inotropes (p=0.328), mechanical support (n=0), arrhythmias (atrial fibrillation, p=0.347; non-sustained ventricular tachycardia, p=0.1), and ventilator support time (p=0.162). No operative mortality occurred. Similarly, no significant differences were found in long-term outcomes. CONCLUSION: Although the three groups showed some significant differences with regard to patient characteristics, both antegrade crystalloid cardioplegia with HTK solution and retrograde cold blood cardioplegia led to early and late clinical results similar to those achieved with combined antegrade and retrograde cold blood cardioplegia.
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spelling pubmed-44632362015-06-15 Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis Lee, Jung Hee Jeong, Dong Seop Sung, Kiick Kim, Wook Sung Lee, Young Tak Park, Pyo Won Korean J Thorac Cardiovasc Surg Clinical Research BACKGROUND: Hypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic stenosis. METHODS: This retrospective study included 225 consecutive patients (mean age, 65±10 years; 123 males) with severe aortic stenosis who underwent aortic valve replacement. Patients were excluded if they had coronary artery disease, an ejection fraction <50%, more than mild aortic regurgitation, or endocarditis. The patients were divided into three groups: group A, which was treated with antegrade and retrograde cold blood cardioplegia; group B, which was treated with antegrade crystalloid cardioplegia using histidine-tryptophan-ketoglutarate (HTK) solution; and group C, treated with retrograde cold blood cardioplegia. RESULTS: Group A contained 70 patients (31.1%), group B contained 74 patients (32.9%), and group C contained 81 patients (36%). The three groups showed significant differences with regard to the proportion of patients with a New York Heart Association functional classification ≥III (p=0.035), N-terminal pro-brain natriuretic peptide levels (p=0.042), ejection fraction (p=0.035), left ventricular dimensions (p<0.001), left ventricular mass index (p<0.001), and right ventricular systolic pressure (p<0.001). Differences in cardiopulmonary bypass time (p=0.532) and aortic cross-clamp time (p=0.48) among the three groups were not statistically significant. During postoperative recovery, no significant differences were found regarding the use of inotropes (p=0.328), mechanical support (n=0), arrhythmias (atrial fibrillation, p=0.347; non-sustained ventricular tachycardia, p=0.1), and ventilator support time (p=0.162). No operative mortality occurred. Similarly, no significant differences were found in long-term outcomes. CONCLUSION: Although the three groups showed some significant differences with regard to patient characteristics, both antegrade crystalloid cardioplegia with HTK solution and retrograde cold blood cardioplegia led to early and late clinical results similar to those achieved with combined antegrade and retrograde cold blood cardioplegia. The Korean Society for Thoracic and Cardiovascular Surgery 2015-06 2015-06-05 /pmc/articles/PMC4463236/ /pubmed/26078922 http://dx.doi.org/10.5090/kjtcs.2015.48.3.164 Text en Copyright © 2015 by The Korean Society for Thoracic and Cardiovascular Surgery. All rights Reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Research
Lee, Jung Hee
Jeong, Dong Seop
Sung, Kiick
Kim, Wook Sung
Lee, Young Tak
Park, Pyo Won
Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis
title Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis
title_full Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis
title_fullStr Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis
title_full_unstemmed Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis
title_short Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis
title_sort clinical results of different myocardial protection techniques in aortic stenosis
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463236/
https://www.ncbi.nlm.nih.gov/pubmed/26078922
http://dx.doi.org/10.5090/kjtcs.2015.48.3.164
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