초록접수 현황
| 15F-253 | 포럼 발표 |
성인심장질환자에서 Del Nido 심정지액 사용의 초기 경험: 혈액성 심정지액과의 비교연구
김지성, 최재웅, 오홍철, 김용한, 안혁, 황호영
서울대학교 의과대학 서울대학교병원 흉부외과학교실
Background : Del Nido cardioplegia has been widely used during pediatric cardiac surgery, because of its non-glucose base and single dose property. However, data using it for adult patients are scarce. We evaluated early results after cardiovascular surgery using the Del Nido cardioplegic solution for adult patients and compared those with outcomes after surgery using blood cardioplegic solution.
Methods : Between September 2014 to August 2015, 87 patients who underwent cardiovascular surgery with cardioplegic arrest using Del Nido cardioplegia (Del Nido group, n = 32) or intermittent blood cardioplegia (Blood group, n = 55) were enrolled. Patients who had a history of previous cardiac surgery or who underwent maze operation, which affects release of myocardial enzyme, were excluded. Peak levels of myocardial enzymes after surgery and early clinical outcomes were compared.
Results : Del Nido cardioplegia was infused with an initial dose of 1000-1500ml, and additional 500ml was infused when the aortic cross clamp (ACC) time prolonged over 90 min (91.5 min after initial dose, n = 11). Blood cardioplegia was infused with an initial dose of 1000-1500ml, and added every 20-40 minutes during ACC. After release of ACC, spontaneous defibrillation was achieved more frequently in Del Nido than Blood groups (29/32 vs 18/55, p < 0.001). Peak levels of TnI and CK-MB after surgery were 14.0 (2.1-153.9) ng/mL and 43.0 (6.7-208.5) ng/mL, respectively. There were no difference in peak levels of myocardial enzymes between the 2 groups (p = 0.247 and 0.203, respectively). A multivariable linear regression model demonstrated that ACC time was the only significant factor affecting peak level of TnI (β for 1min increment = 0.148; 95% confidence interval: 0.001 to 0.296; p = 0.043).
Early mortality occurred in 2 patients (2.3%, 1 in each group). There were no statistical differences in early mortality (p > 0.999) and incidence of postoperative complications including low cardiac output syndrome, new onset arrhythmia, and stroke between the 2 groups.
Conclusion : Del Nido cardioplegia is an effective solution for adult cardiac patients with advantages of less infusion dose and more frequent restoration of self rhythm after ACC compared to the cold intermittent blood cardioglegia.
Methods : Between September 2014 to August 2015, 87 patients who underwent cardiovascular surgery with cardioplegic arrest using Del Nido cardioplegia (Del Nido group, n = 32) or intermittent blood cardioplegia (Blood group, n = 55) were enrolled. Patients who had a history of previous cardiac surgery or who underwent maze operation, which affects release of myocardial enzyme, were excluded. Peak levels of myocardial enzymes after surgery and early clinical outcomes were compared.
Results : Del Nido cardioplegia was infused with an initial dose of 1000-1500ml, and additional 500ml was infused when the aortic cross clamp (ACC) time prolonged over 90 min (91.5 min after initial dose, n = 11). Blood cardioplegia was infused with an initial dose of 1000-1500ml, and added every 20-40 minutes during ACC. After release of ACC, spontaneous defibrillation was achieved more frequently in Del Nido than Blood groups (29/32 vs 18/55, p < 0.001). Peak levels of TnI and CK-MB after surgery were 14.0 (2.1-153.9) ng/mL and 43.0 (6.7-208.5) ng/mL, respectively. There were no difference in peak levels of myocardial enzymes between the 2 groups (p = 0.247 and 0.203, respectively). A multivariable linear regression model demonstrated that ACC time was the only significant factor affecting peak level of TnI (β for 1min increment = 0.148; 95% confidence interval: 0.001 to 0.296; p = 0.043).
Early mortality occurred in 2 patients (2.3%, 1 in each group). There were no statistical differences in early mortality (p > 0.999) and incidence of postoperative complications including low cardiac output syndrome, new onset arrhythmia, and stroke between the 2 groups.
Conclusion : Del Nido cardioplegia is an effective solution for adult cardiac patients with advantages of less infusion dose and more frequent restoration of self rhythm after ACC compared to the cold intermittent blood cardioglegia.
책임저자: 황호영
서울대학교 의과대학 서울대학교병원 흉부외과학교실
연락처 : 김지성, Tel: 010-9091-1272 , E-mail : ttee03@gmail.com
