左心室功能障碍成年患者心脏保护不足的决定因素

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Thoracic and Cardiovascular Surgeon Pub Date : 2024-10-01 Epub Date: 2023-07-26 DOI:10.1055/a-2141-8105
Krzysztof Sanetra, Witold Gerber, Piotr Paweł Buszman, Marta Mazur, Krzysztof Milewski, Paweł Kaźmierczak, Andrzej Bochenek
{"title":"左心室功能障碍成年患者心脏保护不足的决定因素","authors":"Krzysztof Sanetra, Witold Gerber, Piotr Paweł Buszman, Marta Mazur, Krzysztof Milewski, Paweł Kaźmierczak, Andrzej Bochenek","doi":"10.1055/a-2141-8105","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong> Perioperative cardioprotection is essential for achieving satisfactory clinical outcomes in heart failure patients. It is important to understand the factors affecting perioperative cardioprotection.</p><p><strong>Methods: </strong> The institutional database was searched for patients with reduced ejection fraction (EF, < 40%) who underwent surgery with cardioplegia-induced arrest. Patients were divided into del Nido cardioplegia (DN) and cold blood cardioplegia (CB) groups. The relationships between age, preoperative blood parameters, creatinine, cross-clamp time (CCT), extracorporeal circulation time (ECT), and postoperative troponin values at 12 hours or deterioration of EF (≥5%) were evaluated. Baseline characteristics, operative parameters, and outcomes were analyzed.</p><p><strong>Results: </strong> There were 508 patients with reduced EF (331 DN and 177 CB). In the entire cohort, anemic patients had greater troponin values (<i>p</i> = 0.004) as well as in the DN group (<i>p</i> = 0.002). However, this was not detected in the CB group (flat regression line; <i>p</i> = 0.674). Patients with high leukocyte values had greater troponin release (entire cohort: <i>p</i> < 0.001; DN group: <i>p</i> < 0.001; CB group: steep regression line with <i>p</i> = 0.042). Longer CCT and ECT were associated with greater troponin release (entire cohort; both groups) and greater risk of fall in EF. In a direct comparison, fewer patients had significant deterioration of EF in the DN group than CB group (3.9 vs. 11.9%; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong> The use of CB cardioplegia may be beneficial in anemic patients, whereas the use of DN cardioplegia may be beneficial for expected long CCT and high leukocytosis.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Determinants of Inadequate Cardioprotection in Adult Patients with Left Ventricular Dysfunction.\",\"authors\":\"Krzysztof Sanetra, Witold Gerber, Piotr Paweł Buszman, Marta Mazur, Krzysztof Milewski, Paweł Kaźmierczak, Andrzej Bochenek\",\"doi\":\"10.1055/a-2141-8105\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong> Perioperative cardioprotection is essential for achieving satisfactory clinical outcomes in heart failure patients. It is important to understand the factors affecting perioperative cardioprotection.</p><p><strong>Methods: </strong> The institutional database was searched for patients with reduced ejection fraction (EF, < 40%) who underwent surgery with cardioplegia-induced arrest. Patients were divided into del Nido cardioplegia (DN) and cold blood cardioplegia (CB) groups. The relationships between age, preoperative blood parameters, creatinine, cross-clamp time (CCT), extracorporeal circulation time (ECT), and postoperative troponin values at 12 hours or deterioration of EF (≥5%) were evaluated. Baseline characteristics, operative parameters, and outcomes were analyzed.</p><p><strong>Results: </strong> There were 508 patients with reduced EF (331 DN and 177 CB). In the entire cohort, anemic patients had greater troponin values (<i>p</i> = 0.004) as well as in the DN group (<i>p</i> = 0.002). However, this was not detected in the CB group (flat regression line; <i>p</i> = 0.674). Patients with high leukocyte values had greater troponin release (entire cohort: <i>p</i> < 0.001; DN group: <i>p</i> < 0.001; CB group: steep regression line with <i>p</i> = 0.042). Longer CCT and ECT were associated with greater troponin release (entire cohort; both groups) and greater risk of fall in EF. In a direct comparison, fewer patients had significant deterioration of EF in the DN group than CB group (3.9 vs. 11.9%; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong> The use of CB cardioplegia may be beneficial in anemic patients, whereas the use of DN cardioplegia may be beneficial for expected long CCT and high leukocytosis.</p>\",\"PeriodicalId\":23057,\"journal\":{\"name\":\"Thoracic and Cardiovascular Surgeon\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Thoracic and Cardiovascular Surgeon\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2141-8105\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/7/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Thoracic and Cardiovascular Surgeon","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2141-8105","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/7/26 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

摘要

背景:围术期心脏保护对于心衰患者获得满意的临床疗效至关重要。了解影响围术期心脏保护的因素非常重要:方法:在机构数据库中搜索射血分数(EF)降低的患者:共有 508 例射血分数降低的患者(331 例 DN 和 177 例 CB)。在整个队列中,贫血患者的肌钙蛋白值较高(p = 0.004),DN 组也是如此(p = 0.002)。但在 CB 组中却没有发现这种情况(回归线持平;p = 0.674)。白细胞值高的患者肌钙蛋白释放量更大(整个队列:p p = 0.042)。较长的 CCT 和 ECT 与较多的肌钙蛋白释放有关(整个队列;两组均是),且 EF 下降的风险更大。在直接比较中,DN 组 EF 明显恶化的患者少于 CB 组(3.9% 对 11.9%;P 结论:使用 CB 心脏麻痹可能对贫血患者有益,而使用 DN 心脏麻痹可能对预期的长 CCT 和高白细胞率患者有益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Determinants of Inadequate Cardioprotection in Adult Patients with Left Ventricular Dysfunction.

Background:  Perioperative cardioprotection is essential for achieving satisfactory clinical outcomes in heart failure patients. It is important to understand the factors affecting perioperative cardioprotection.

Methods:  The institutional database was searched for patients with reduced ejection fraction (EF, < 40%) who underwent surgery with cardioplegia-induced arrest. Patients were divided into del Nido cardioplegia (DN) and cold blood cardioplegia (CB) groups. The relationships between age, preoperative blood parameters, creatinine, cross-clamp time (CCT), extracorporeal circulation time (ECT), and postoperative troponin values at 12 hours or deterioration of EF (≥5%) were evaluated. Baseline characteristics, operative parameters, and outcomes were analyzed.

Results:  There were 508 patients with reduced EF (331 DN and 177 CB). In the entire cohort, anemic patients had greater troponin values (p = 0.004) as well as in the DN group (p = 0.002). However, this was not detected in the CB group (flat regression line; p = 0.674). Patients with high leukocyte values had greater troponin release (entire cohort: p < 0.001; DN group: p < 0.001; CB group: steep regression line with p = 0.042). Longer CCT and ECT were associated with greater troponin release (entire cohort; both groups) and greater risk of fall in EF. In a direct comparison, fewer patients had significant deterioration of EF in the DN group than CB group (3.9 vs. 11.9%; p < 0.001).

Conclusion:  The use of CB cardioplegia may be beneficial in anemic patients, whereas the use of DN cardioplegia may be beneficial for expected long CCT and high leukocytosis.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
×
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