ABSTRACT
ABSTRACT Introduction: This study evaluated myocardial protection and clinical outcomes when using lactated Ringer's solution as the base solution for del Nido cardioplegia compared with histidine-tryptophan-ketoglutarate (HTK) solution in valvular surgery. Methods: From January 2017 to May 2018, 71 adult patients who underwent valvular surgery with del Nido cardioplegia (n=37) or HTK cardioplegia (n=34) were retrospectively analyzed. Results: Patients' characteristics were comparable between groups. Postoperative peak troponin T levels were similar. The del Nido group had a decreased incidence of ventricular fibrillation after aortic cross-clamp removal (13.51 vs. 55.88%; P<0.001), lower total volume of cardioplegia administered (1,000 [1,000, 1,250] vs. 1,800 [1,500, 2,000] mL; P<0.001), shorter hospital stay (6 [5, 8] vs. 7 [6, 10] days; P=0.03), and less postoperative red cell transfusion (34.29 vs. 61.11%; P=0.024). There is no difference in aortic cross-clamping time, postoperative change in left ventricular ejection fraction, intensive care unit stay, duration of inotropic support, new onset of atrial fibrillation, in-hospital mortality, complications, and three-year overall survival rate. Conclusion: Lactated Ringer's-based del Nido cardioplegia can be safely used for valvular surgery with acceptable clinical outcomes compared to HTK cardioplegia.
ABSTRACT
BACKGROUND: The outcome of the off-pump coronary artery bypass grafting (CABG) is highly dependent on surgical techniques. To overcome problems of intraoperative hemodynamic instability and avoid potential injury to coronary artery arising from occlusive technique, the authors have modified the strategy of performing distal anastomosis by using the authors' homemade intracoronary artery shunt. OBJECTIVE: To document the results of off-pump CABG using the authors' homemade intracoronary shunt. The characteristics of shunt and techniques are demonstrated. MATERIAL AND METHOD: The shunt is constructed from silicone tubing (Allied Biomedical Company, Paso Robles, CA). It has been successfully used for distal anastomoses in off-pump coronary artery bypass surgery. All 170 consecutive patients who had off-pump CABG from October 2002 to May 2005 were evaluated. Data were collected retrospectively. Average grafts per patient were 3.5. Arterial grafts were used in most cases (90%). Conversion rate was 2.8%. Patients were followed up at 3 weeks, 6 weeks, and bimonthly thereafter. RESULTS: In a 23-month follow-up, the operative mortality rate was 0.5% (one patient). Complications included stroke in 3 patients (1.8%) and post-operative AF in 12 patients (7.12%). Of 170 patients, 12 patients (7.05%) required intraoperative or postoperative intraaortic balloon pump support. The early results were good and satisfactory. CONCLUSION: Off-pump CABG can be successfully performed using the authors' homemade intracoronary artery shunt with better hemodynamic control. The techniques are safe, simple, reliable, and effective.