초록접수 현황
| 14F-238 | 포럼 발표 |
Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis: Antegrade Versus Retrograde
Jung Hee Lee, Dong Seop Jeong, Ji Hyuk Ynag, Wook Sung Kim, Kiick Sung, Young Tak Lee, Tae-Gook Jun, Pyo Won Park
Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
Background : It is known that hypertrophied myocardium is especially more vulnerable to ischemic injury. Most concern about retrograde delivery of cardioplegia as a sole method regarding to the protection of the right ventricle and the posterior ventricular septum. This study aimed to compare early and late clinical outcomes of each three different method of institution’s myocardial protection in patients with aortic stenosis (AS)
Methods : This retrospective study comprised 225 consecutive patients(mean age, 65.35 ±10.05 years; 123 males) with severe AS undergoing aortic valve replacement. Patients with coronary artery disease, left ventricular dysfunction (ejection fraction < 50%), more than mild aortic regurgitation, endocarditis were excluded. According to the method of myocardial protection, patients were divided into three groups: 1) Group A, combined initial antegrade and retrograde cold blood; 2) Group B, single antegrade crystalloid cardioplegia with HTK solution ; 3) Group C, retrograde cold blood alone.
Results : There were 70 (31.1%) patients in group A, 74 (32.9%) patients in group B and 81 (36%) patients in group C. Patient’s demographics showed significant differences in NYHA ≥III (p=0.035), NT-proBNP(p=0.042), ejection fraction (p=0.035), LV internal dimension (p<0.001), LV mass index (p<0.001) and RVSP (p<0.001). The CPB time (p=0.532) and ACC time (0.48) of each groups were not statistically significant. During postoperative recovery, any significant differences was not found in postoperative inotropics use (p<0.328), mechanical circulatory support and arrhythmias(AF, p=0.347; NSVT, p=0.1), ventilator support time(p=0.162). No operative mortality was found. Late outcome also showed no significant differences.
Conclusion : Single antegrade HTK solution is acceptable method and retrograde blood alone is safe technique in myocardial protection in patients with AS.
Methods : This retrospective study comprised 225 consecutive patients(mean age, 65.35 ±10.05 years; 123 males) with severe AS undergoing aortic valve replacement. Patients with coronary artery disease, left ventricular dysfunction (ejection fraction < 50%), more than mild aortic regurgitation, endocarditis were excluded. According to the method of myocardial protection, patients were divided into three groups: 1) Group A, combined initial antegrade and retrograde cold blood; 2) Group B, single antegrade crystalloid cardioplegia with HTK solution ; 3) Group C, retrograde cold blood alone.
Results : There were 70 (31.1%) patients in group A, 74 (32.9%) patients in group B and 81 (36%) patients in group C. Patient’s demographics showed significant differences in NYHA ≥III (p=0.035), NT-proBNP(p=0.042), ejection fraction (p=0.035), LV internal dimension (p<0.001), LV mass index (p<0.001) and RVSP (p<0.001). The CPB time (p=0.532) and ACC time (0.48) of each groups were not statistically significant. During postoperative recovery, any significant differences was not found in postoperative inotropics use (p<0.328), mechanical circulatory support and arrhythmias(AF, p=0.347; NSVT, p=0.1), ventilator support time(p=0.162). No operative mortality was found. Late outcome also showed no significant differences.
Conclusion : Single antegrade HTK solution is acceptable method and retrograde blood alone is safe technique in myocardial protection in patients with AS.
책임저자: 박표원
성균관대학교 의과대학, 삼성서울병원 흉부외과
연락처 : 이정희, Tel: 02-3410-1677 , E-mail : junghee.lee2010@gmail.com
