Ayse LAFCI, Derya GOKCINAR, Ali Baran BUDAK, Kevin MCCUSKER, Osman DAG, Serdar GUNAYDIN

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

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

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.

Keywords:

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

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