The cardioprotective effects of HTK solution and conventional blood cardioplegia in patients with atrial fibrillation undergoing valvular replacement and Cox maze III procedure.

IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
BingMei Qiu, Lei Zhang, Dan Wu, Qian Li, Lei Sun, AnLi Wang, Zhilong Xi, HaiWei Wu, ChangTian Wang, ShanWu Feng
{"title":"The cardioprotective effects of HTK solution and conventional blood cardioplegia in patients with atrial fibrillation undergoing valvular replacement and Cox maze III procedure.","authors":"BingMei Qiu, Lei Zhang, Dan Wu, Qian Li, Lei Sun, AnLi Wang, Zhilong Xi, HaiWei Wu, ChangTian Wang, ShanWu Feng","doi":"10.1186/s13019-024-03317-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The study was to assess the myocardial protection effects of the histidine-tryptophan-ketoglutarate (HTK) solution and the 4:1 blood cardioplegia (BC) in patients with atrial fibrillation (AF) who were subjected to valvular replacement concomitant with the Cox maze III surgery.</p><p><strong>Methods: </strong>A cohort of 148 individuals afflicted with AF, who received valve replacement surgery in conjunction with the Cox maze III procedure at our clinic within the period extending from 2015 to 2023, were enrolled. Subsequent to adjustment by propensity score matching (PSM), the patients were categorized into two distinct groups: the HTK group and the BC group. The primary end points assessed inotropic support requirements, complications, troponin trend, mechanical ventilation time and the intensive care unit stay. Arrhythmias, aortic cross-clamp and cardiopulmonary bypass times, and other clinical perioperative variables were considered as secondary end points.</p><p><strong>Results: </strong>No substantive disparities were observed concerning mortality rates, arrhythmias, neurological events, or renal complications. The duration of cardiopulmonary bypass and the aortic cross-clamp time did not demonstrate any marked variations between both groups, with p-values of 0.71 and 0.05, respectively. The time required for weaning from mechanical ventilation and the length of postoperative hospitalization were notably less in the group receiving HTK solution (p < 0.001 and p = 0.03, respectively). While inotropic support need was higher in the BC group (p = 0.02). Conversely, the dosage and frequency of perfusions were considerably increased in the BC group (p < 0.001 for each parameter). Within subgroups stratified by longer than 150 min of aortic cross-clamping duration, those in the BC cohort had significantly elevated peaks of cardiac troponin I (cTnI) (p = 0.01), whereas individuals in the HTK group experienced less mechanical ventilation time (p = 0.002) and shorter durations of intensive care unit admission (p < 0.001). The LVEF value in the HTK group was higher compared to that in the BC group in the 3-month follow-up data (p = 0.02).</p><p><strong>Conclusions: </strong>Both the HTK and 4:1 blood cardioplegia could be used safely in patients with AF who were subject to valvular replacement and Cox maze III procedure. However, the utilization of HTK conferred a greater advantage in diminishing the duration of mechanical ventilation weaning and the duration of postoperative hospitalization. HTK may be a better myocardial protection in patients with long cross-clamp time. The follow-up data indicated that HTK might be superior to 4:1 blood cardioplegia in the short-medium term cardiac function.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"25"},"PeriodicalIF":1.5000,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiothoracic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13019-024-03317-2","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction: The study was to assess the myocardial protection effects of the histidine-tryptophan-ketoglutarate (HTK) solution and the 4:1 blood cardioplegia (BC) in patients with atrial fibrillation (AF) who were subjected to valvular replacement concomitant with the Cox maze III surgery.

Methods: A cohort of 148 individuals afflicted with AF, who received valve replacement surgery in conjunction with the Cox maze III procedure at our clinic within the period extending from 2015 to 2023, were enrolled. Subsequent to adjustment by propensity score matching (PSM), the patients were categorized into two distinct groups: the HTK group and the BC group. The primary end points assessed inotropic support requirements, complications, troponin trend, mechanical ventilation time and the intensive care unit stay. Arrhythmias, aortic cross-clamp and cardiopulmonary bypass times, and other clinical perioperative variables were considered as secondary end points.

Results: No substantive disparities were observed concerning mortality rates, arrhythmias, neurological events, or renal complications. The duration of cardiopulmonary bypass and the aortic cross-clamp time did not demonstrate any marked variations between both groups, with p-values of 0.71 and 0.05, respectively. The time required for weaning from mechanical ventilation and the length of postoperative hospitalization were notably less in the group receiving HTK solution (p < 0.001 and p = 0.03, respectively). While inotropic support need was higher in the BC group (p = 0.02). Conversely, the dosage and frequency of perfusions were considerably increased in the BC group (p < 0.001 for each parameter). Within subgroups stratified by longer than 150 min of aortic cross-clamping duration, those in the BC cohort had significantly elevated peaks of cardiac troponin I (cTnI) (p = 0.01), whereas individuals in the HTK group experienced less mechanical ventilation time (p = 0.002) and shorter durations of intensive care unit admission (p < 0.001). The LVEF value in the HTK group was higher compared to that in the BC group in the 3-month follow-up data (p = 0.02).

Conclusions: Both the HTK and 4:1 blood cardioplegia could be used safely in patients with AF who were subject to valvular replacement and Cox maze III procedure. However, the utilization of HTK conferred a greater advantage in diminishing the duration of mechanical ventilation weaning and the duration of postoperative hospitalization. HTK may be a better myocardial protection in patients with long cross-clamp time. The follow-up data indicated that HTK might be superior to 4:1 blood cardioplegia in the short-medium term cardiac function.

HTK溶液和常规血停搏液对心房颤动瓣膜置换术和Cox maze III手术患者的心脏保护作用
前言:本研究旨在评估组氨酸-色氨酸-酮戊二酸(HTK)溶液和4:1血停搏率(BC)对行瓣膜置换术合并Cox maze III手术的房颤(AF)患者的心肌保护作用。方法:纳入148例房颤患者,这些患者在2015年至2023年期间在我们的诊所接受了瓣膜置换术和Cox迷宫III手术。通过倾向评分匹配(PSM)调整后,将患者分为两组:HTK组和BC组。主要终点评估了肌力支持需求、并发症、肌钙蛋白趋势、机械通气时间和重症监护病房住院时间。心律失常、主动脉交叉钳夹和体外循环次数以及其他临床围手术期变量被视为次要终点。结果:在死亡率、心律失常、神经事件或肾脏并发症方面没有观察到实质性差异。两组患者体外循环时间和主动脉交叉夹夹时间差异无统计学意义,p值分别为0.71和0.05。HTK溶液组机械通气脱机时间和术后住院时间明显少于对照组(p)。结论:HTK和4:1血停搏均可安全用于行瓣膜置换术和Cox maze III手术的房颤患者。然而,HTK的使用在减少机械通气脱机时间和术后住院时间方面具有更大的优势。HTK对交叉钳夹时间较长的患者可能有较好的心肌保护作用。随访资料显示,HTK在中短期心功能方面可能优于4:1血停搏。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of Cardiothoracic Surgery
Journal of Cardiothoracic Surgery 医学-心血管系统
CiteScore
2.50
自引率
6.20%
发文量
286
审稿时长
4-8 weeks
期刊介绍: Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信