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Objective:To explore the myocardial protective effect of nicorandil preoperative intervention on patients with heart disease undergoing hip replacement surgery.Methods:The case data of 117 patients undergoing hip arthroplasty in Rugao Branch Affiliated Hospital of Nantong University from June 2018 to December 2020 were retrospectively analyzed. According to whether nicorandil was given before surgery, they were divided into two groups. The group A and group B was given routine preoperative general anesthesia, and the group B was given nicorandil before surgery. The surgery-related indicators, inflammatory factors, myocardial damage, major adverse cardiac events (MACE) werecompared between the two groups.Results:The operation time, intraoperative blood loss, intraoperative fluid rehydration, urine output, Ramsay sedation score on the first day after surgery, visual analogue scale (VAS) score on the first day after surgery, and hospital stay in the two groups had no significant differences ( P>0.05). The levels of serum interleukin-6, tumor necrosis factor -α, C-reactive protein, cardiac troponin I, creatine kinase-MB, myoglobin andipoprotein associated phospholipase A2 postoperative in group B were lower than those in the group A: (388.15 ± 56.20) μg/L vs. (456.34 ± 65.18) μg/L, (34.24 ± 8.90) μg/L vs. (40.26 ± 10.22) μg/L, (27.54 ± 5.52) mg/L vs. (30.25 ± 5.61) mg/L, (0.10 ± 0.05) μg/L vs. (0.19 ± 0.08) μg/L, 0.059 ± 0.019 vs. 0.099 ± 0.026, (68.41 ± 6.03) μg/L vs. (76.61 ± 6.54) μg/L, (201.67 ± 25.88) μg/L vs. (251.37 ± 31.06) μg/L, the differences were statistically significant ( P<0.05). There was no statistically significant difference in the total incidence of MACE between the two groups ( P>0.05). Conclusions:Nicorandil intervention before hip replacement surgery can effectively improve the levels of inflammatory factors in patients with heart disease and reduce the degree of myocardial damage.Whether it can reduce the risk of MACE after surgery still needs to be further demonstrated.
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@#Objective To compare and analyze the effect of myocardial protection between HTK and del Nido cardioplegia solutions in neonates with surgeries for transposition of the great arteries. Methods The clinical data of 208 neonates with complete transposition of the great arteries in our institution from 2014 to 2020 were retrospectively analyzed. According to the cardioplegia solutions utilized in the operations, the patients were divided into two groups: a HTK group and a del Nido group. Propensity score matching was conducted to eliminate the biases. The cardiopulmonary bypass time, aortic cross-clamping time, total amount of cardioplegia solutions, transfusion frequency of cardioplegia, ICU stay time, mechanical support time, inotropic score, hospital stay, left ventricular ejection fraction, N-terminal proBNP and troponin I were compared and analyzed between the two groups after matching. Results After 1:1 propensity score matching, a total of 54 patients were analyzed with 27 patients in each group. In the HTK group, there were 22 males and 5 females with a median age of 7.0 (2.0, 11.0) d. In the del Nido group, there were 23 males and 4 females with a median age of 8.0 (3.0, 11.0) d. A total of 3 children died after the surgery: 2 (7.4%) patients in the HTK group and 1 (3.7%) patient in the del Nido group. There was no significant difference in hospital mortality between the two groups (P=1.000). The total amount of cardioplegia solutions in the HTK group was significantly higher than that of del Nido group (P<0.001). Transfusion frequency of cardioplegia in del Nido group was significantly higher than that of the HTK group (P=0.043). There was no significant difference in the postoperative ICU time, mechanical support time, length of hospital stay, inotropic score, left ventricular ejection fraction, N-terminal B-type natriuretic peptide precursor or troponin I between the two groups (P>0.05). Conclusion For neonates with surgeries for complete transposition of the great arteries, HTK cardioplegia solutions can provide effective and safe myocardial protection, which is similar to del Nido cardioplegia solutions.
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La cirugía a "corazón abierto" con circulación extracorpórea se apronta a cumplir 70 años. Desde un comienzo se hizo necesario buscar la forma de tener un campo operatorio quieto y exangüe, sin riesgo de embolia aérea, lo que llevó al desarrollo de la primera "cardioplegía" por Melrose, a fines de los años 1950's. Sin embargo, esta cayó en descrédito rápidamente y fue abandonada en años 1960's. Se necesitó que transcurrieran casi 15 años para el retorno de la cardioplegía, ahora como forma de proteger al corazón de la isquemia. Durante este periodo se volvió a la fibrilación ventricular a la perfusión coronaria, al paro isquémico y a la hipotermia tópica. Sin embargo, algunos investigadores mantuvieron su interés en la cardioplegía, facilitando el retorno clínico de esta con Hearse en 1976, con la solución cardioplégica cristaloide del Hospital St. Thomas, la que se asentó como el principal método de protección miocárdica, hasta la irrupción de Buckberg con su cardioplegía sanguínea en multidosis, la que se convirtió, a comienzo de los años 1990's, en el procedimiento preferido para proteger al corazón durante el periodo de isquemia requerido para operar en él, infundida ahora no solo por vía anterógrada, sino que también por vía retrógrada. Esto, hasta Pedro Del Nido y su vuelta a la dosis única, solo por vía anterógrada.
Open heart surgery with extracorporeal circulation is approaching its 70th anniversary. From the beginning it was necessary to find a way to have a still and bloodless operative field, without the risk of air embolism, which led to the development of the first "cardioplegía" by Melrose, at the end of the 1950's. However, it quickly fell into disrepute and was abandoned in the 1960's. It took almost 15 years for cardioplegía to return, now as a way of protecting the heart from ischemia. During this period, ventricular fibrillation, coronary perfusion, ischemic arrest and topical hypothermia returned. However, some investigators maintained their interest in cardioplegía, facilitating the clinical return of cardioplegía with Hearse in 1976, with the crystalloid cardioplegic solution of St. Thomas's Hospital. This became the main method of myocardial protection until the irruption of Buckberg with his multidose blood cardioplegía, which became, at the beginning of the 90's, the preferred method to protect the heart during the ischemic period required to operate on it, now infused not only by anterograde route but also by retrograde route. This, until Pedro Del Nido and his return to the single dose, only via the antegrade route.
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Humans , Thoracic Surgery/trends , Surgical Procedures, Operative , Cardiomyopathies/prevention & controlABSTRACT
Abstract Introduction: There is not enough data in the literature regarding the safety and efficiency of del Nido cardioplegia in patients with prolonged cross-clamping time. This study aims to determine the efficacy and safety of del Nido cardioplegia compared to cold blood cardioplegia in patients with prolonged aortic cross-clamping time. Methods: In this retrospective study, patients with an aortic cross-clamping time ≥ 90 minutes were included. One hundred consecutive adult patients undergoing cardiac surgery using del Nido cardioplegia comprised the study group, and 100 consecutive adult patients undergoing cardiac surgical procedures using cold blood cardioplegia comprised the control group. Propensity score matching yielded 88 del Nido cardioplegia and 88 cold blood cardioplegia patients. Results: There were no significant differences when comparing the matched groups regarding the requirement for intraoperative defibrillation, postoperative peak troponin T levels, inotropic support, intra-aortic balloon pump requirement, and left ventricular ejection fraction at discharge and on the sixth postoperative month; also, there were no significant differences when comparing cardiopulmonary bypass time and total operation time. Mean cross-clamping time was significantly shorter in the del Nido group (P<0.001). Conclusion: Del Nido cardioplegia may be a safe alternative to cold blood cardioplegia in adults undergoing cardiac surgical procedures with prolonged aortic cross-clamping time.
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Objective:To investigate the protective role and mechanism of hypoxia inducible factor(HIF)-1α in myocardial ischemia postconditioning.Methods:Forty healthy adult SD rats were randomly divided into four groups with 10 rats in each group.The control group(group A)was sham operation group, and the rats underwent the same surgical procedures except that the suture passed under the left anterior descending branch(LAD)of the coronary artery was not tightened for 225 minutes.In the ischemia-reperfusion group(group B), the LAD was blocked for 45 minutes, and then reperfusion for 3 hours.In the ischemic postconditioning group(group C), 45 minutes after blocking the LAD, reperfusion was performed for 10 seconds-ischemia for 10 seconds at the beginning of reperfusion, a total of 3 cycles of intervention, and reperfusion for 3 hours.Ischemic postconditioning + HIF-1α inhibitor group(group D): 45 minutes after blocking the LAD, HIF-1α inhibitor AG490 (3 μg/g) was injected intraperitoneally, and reperfusion was performed for 10 seconds-ischemia 10 seconds at the moment of reperfusion.A total of 3 cycles of intervention, reperfusion for 3 hours.Blood samples were harvested from femoral vein at three time points(before ligation of the LAD, 45 minutes after ischemia, 3 hours after reperfusion)to analyze the serum levels of creatine kinase and cardiac troponin respectively.After 3 hours of reperfusion, myocardial tissue was used to measure the infarction size through 2, 3, 5-triphenyltetrazolium chloride staining method; and Western blot method was used to detect the expression of HIF-1α in each group.Results:(1) There were no significant differences in the serum levels of creatine kinase and cardiac troponin among four groups before ligation( P>0.05); 45 minutes after ischemia, there were significant differences between group B, group C, and group D compared with group A ( P<0.01). After 3 hours of reperfusion, there were significant differences between group B, group C, and group D compared with group A (all P<0.01), and group B, group D were significantly higher than that in group C ( P<0.05). (2)Compared with group A[(2.46±1.13)%], the area of myocardial infarction in group B was (45.81±5.96)%, in group C was (37.17±4.99)%, and group D was (45.00±3.29) %, and the differences were statistically significant ( P<0.01). (3)The HIF-1α protein in myocardial tissue in group A was slightly expressed; the expression of HIF-1α protein in group B was higher than that in group A( P<0.05); and group C was significantly higher than that in group B ( P<0.05); HIF-1α protein was almost not expressed in group D. Conclusion:After ischemic postconditioning, HIF-1α increased in myocardium; the increased expression of HIF-1α may be involved in the protective process of myocardial ischemic postconditioning in rats.
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Objective:To discuss the safety and effectiveness of del Nido cardioplegia solution in severe valvular surgery.Methods:A retrospective analysis of 138 patients of severe valvular disease underwent valve replacement or valvuloplasty in Hunan Provincial People′s Hospital between July 2019 and December 2020 was performed. According to the different cardioplegic solution used, patients were separated in two groups: the del Nido cardioplegia group (D group, n=73) and the St. Thomas cardioplegia group (C group, n=65). The perioperative clinical results of the two groups were compared to evaluate the safety and effectiveness of del Nido cardioplegia in the operation of severe valvular disease. Results:Preoperative characteristics were similar between the two groups, including gender, age, body weight, ejection fraction, and myocardial markers ( P>0.05). No statistical differences were noted in cardiopulmonary bypass time, clamp time, mechanical ventilation time, vasoactive drug use time, ICU and hospital stay time, and ejection fraction before discharge ( P>0.05). However, the times of cardioplegia perfusion [(1.33±0.47)times vs (4.08±0.48)times] and the total perfusion time [(3.96±1.41)min vs (13.15±1.46)min] in group D were lower than those in group C, while the automatic rebound rate (90.41% vs 76.92%) was higher than that in group C ( P<0.05). Both groups successfully completed the operation. There were no serious complications of important organs such as low cardiac output, brain, liver and kidney during and after the operation. There were no deaths during hospitalization, and all patients were cured and discharged. Conclusions:There was no significant difference in myocardial protection between del Nido and St. Thomas cardioplegia solution in severe valvular surgery. The application of del Nido cardioplegia could reduce the frequency of perfusions and total perfusion time.
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Mitochondrial unfolded protein response (UPR mt) is a protein-toxic stress response, which regulates the communication from mitochondria to the nucleus. It is activated when a large number of unfolded or misfolded proteins accumulate in the mitochondria. The activation of UPR mt increases the expression of a series of chaperones and proteases, and maintains the homeostasis and function of mitochondrial proteins. Mitochondria play an important role in maintaining cardiomyocyte homeostasis. The damage of myocardial mitochondria leads to the metabolic disorder of cells suffering from ischemia/reperfusion injury. It is the key mechanism of myocardial cell death. This article mainly reviews the regulatory pathway of UPR mt and the research progress of UPR mt in myocardial ischemia/reperfusion injury (MIRI), in order to provide new ideas for the treatment of MIRI.
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Coronary–cameral fistulas (CCFs) are mostly congenital in origin and rarely acquired. Clinical symptoms are decided by the hemodynamic significance of the coronary fistula. Even in asymptomatic patients, it is essential to know about coronary CCF particularly if the patient is to undergo cardiac surgery with cardioplegic cardiac arrest. Incidental finding of coronary CCF should never be ignored. Intraoperative myocardial protection and methods used are significantly influenced by such fistula.
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Preconditioning, a milestone concept in the cardiovascular sciences introduced 32 years back by Murry. This concept opened a new era in the field of organ protection. To start with extensive studies done on ischemic preconditioning for myocardial protection, ischemic preconditioning is an endogenous science of cellular kinetics. Several components in signal transduction cascade have been identified but still some mechanisms not yet revealed. Anesthetic preconditioning also contributed a lot for myocardial protection and concreted the concept of preconditioning. We, with an inquisitive brain meticulously persuing newer methods of cardioprotection. Remote ischemic preconditioning (RIPC) is a brilliant example of it. RIPC can be future of cardioprotection, clinical trials and studies proved the benefits but yet to conclude the superiority of RIPC over myocardial ischemic cardioprotection. This review is an attempt to reveal this extraordinary concept with its basic cellular kinetics, methods, and recent trends.
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RESUMEN Introducción: Tradicionalmente, en las intervenciones cardiovasculares de pacientes adultos que requieren de circulación extracorpórea, se utiliza la solución cardioplégica de Buckberg, mientras que en cirugía cardíaca infantil se emplea con mayor frecuencia la solución de Del Nido. Este es el primer reporte argentino de la experiencia con esta última cardioplegía en pacientes adultos. Material y métodos: Desde noviembre de 2016 hasta marzo de 2018, el mismo equipo quirúrgico realizó 267 cirugías cardíacas en dos centros de cirugía cardiovascular; de ese total, a 50 pacientes se les realizó la cardioplegía de Del Nido (grupo DN) y se los comparó con un grupo homogéneo de 50 pacientes que recibieron cardioplegía de Buckberg (grupo BK). Resultados: En promedio, el tiempo total de cirugía, de circulación extracorpórea y de clampeo aórtico fueron, respectivamente, 126,70 min, 70,63 min y 54 min en el grupo DN y 165,78 min, 80,5 min y 64,21 min en el grupo BK; estas diferencias fueron estadísticamente significativas (p = 0,001, p = 0,0032 y p = 0,0004, respectivamente). Las comorbilidades y el tipo de cirugía valvular realizada fueron similares en ambos grupos. Conclusión: La cardioplegía de Del Nido puede utilizarse en pacientes adultos con excelentes resultados; esta permite disminuir significativamente los tiempos de cirugía, clampeo aórtico y circulación extracorpórea, con todos los beneficios que esto conlleva.
ABSTRACT Background: Traditionally, Buckberg cardioplegic solution is used for cardiovascular interventions in adult patients requiring cardiopulmonary bypass, whereas Del Nido solution is more commonly used in pediatric cardiac surgery. This is the first Argentine report of Del Nido cardioplegia in adult patients. Methods: From November 2016 to March 2018, 267 cardiac surgeries were performed by the same surgical team in two cardiovascular surgery centers. Among the total number of patients undergoing these surgeries, 50 received Del Nido cardioplegia (DN group) and were compared with a homogeneous group of 50 patients receiving Buckberg cardioplegia (BK group). Results: Average total operative, cardiopulmonary bypass and aortic cross-clamp times (128.80 min, 70.83 min and 55 min, respectively, in the DN group, and 167.78 min, 80.7 min and 64.71min, in the BK group) were statistically significant between groups (p=0.001, p=0.0032 and p=0.0004, respectively). Comorbidities and type of valve surgery were similar in both groups Conclusions: Del Nido cardioplegia can be used in adult patients with excellent results, allowing to significantly shorten operative, aortic cross-clamp and cardiopulmonary bypass times, with all the benefits these lower times entail.
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Objective: The objective of this study was to assess the cardioprotective effect of magnesium sulfate in patients with left ventricular concentric hypertrophy undergoing cardiac surgery. Design: The study was a double-blinded randomized study. Setting: This study was conducted at a cardiac center. Patients: The study included 250 patients. Intervention: The study included two groups (each = 125): Group M – the patients who received magnesium sulfate infusion (15 mg/kg/h). The infusion was started 20 min before induction, during surgery, and the first postoperative 24 h. Group C – the patients who received an equal amount of normal saline. Measurements: The variables included troponin I level, creatinine kinase-MB (CK-MB) level, electrocardiograph (ECG) with automatic ST-segment analysis (leads II and V), E/A peak ratio, end-diastolic volume, cardiac index (CI), heart rate, mean arterial blood pressure (MAP), mean arterial pulmonary pressure (mPAP), pulmonary and systemic vascular resistances, and pharmacological and mechanical support. Main Results: The troponin I level, CK-MB, and ECG changes were lower in Group M than Group C (P < 0.05). The E/A peak ratio and end-diastolic volume increased in Group M than Group C (P < 0.05). There was a significant increase in the CI and a decrease in the heart rate, mPAP, pulmonary vascular resistances, and pharmacological and mechanical support in Group M compared to Group C (P < 0.05). There were minimal changes in the MAP and systemic vascular resistance in Group M compared to Group C (P < 0.05). Conclusion: The magnesium sulfate provides a cardioprotective effect in patients with concentric ventricular hypertrophy undergoing cardiac surgery. It decreases the incidence of perioperative myocardial infarction and arrhythmia. Furthermore, it decreases the requirement of pharmacological and mechanical support.
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Abstract Objective: The goal of the present study was to compare the myocardial protection obtained with histidine-tryptophan-ketoglutarate (HTK) cardioplegic solution (Custodiol®) and with intermittent hypothermic blood solution. Methods: Two homogenous groups of 25 children with acyanotic congenital heart disease who underwent total correction with mean aortic clamping time of 60 minutes were evaluated in this randomized study. Troponin and creatine kinase-MB curves, vasoactive-inotropic score, and left ventricular function were obtained by echocardiogram in each group. The values were correlated and presented through graphs and tables after adequate statistical treatment. Results: It was observed that values of all the studied variables varied over time, but there was no difference between the groups. Conclusion: We conclude that in patients with acyanotic congenital cardiopathies submitted to total surgical correction, mean aortic clamping time around one hour, and cardiopulmonary bypass with moderate hypothermia, the HTK crystalloid cardioplegic solution offers the same myocardial protection as the cold-blood hyperkalemic cardioplegic solution analyzed, according to the variables considered in our study model.
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Humans , Male , Female , Infant, Newborn , Infant , Cardioplegic Solutions/therapeutic use , Heart Defects, Congenital/surgery , Potassium Chloride/therapeutic use , Procaine/therapeutic use , Reference Values , Time Factors , Troponin/analysis , Echocardiography , Double-Blind Method , Prospective Studies , Reproducibility of Results , Analysis of Variance , Ventricular Function, Left , Treatment Outcome , Statistics, Nonparametric , Protective Agents/therapeutic use , Creatine Kinase, MB Form/analysis , Operative Time , Glucose/therapeutic use , Heart Defects, Congenital/physiopathology , Mannitol/therapeutic useABSTRACT
Objective@#To investigate the effect of Calcium dibutyryladenosine cyclophosphate on myocardial ischemia-reperfusion injury in patients undergoing coronary artery bypass grafting (CABG) operation.@*Methods@#The clinical data of 62cases were retrospectively analyzed. These patients were performed coronary artery bypass graft (CABG) operation under cardiopulmonary bypass (CPB) in the First Affiliated Hospital of Medical College of Xi′an Jiaotong University from January 2013 to January 2016. According to the use calcium dibutyryladenosine cyclophosphate, 62 patients were divided into the control group and the experimental group. Thirty-one cases in the experimental group were given an intravenous drip of calcium dibutyryladenosine cyclophosphate, while other 31 cases in the control group were not given to calcium dibutyryladenosine cyclophosphate during perioperative period. Venous blood was collected from each patient 1 h before the surgery and 2, 6, 24 and 72 h after unclamping the aorta, then serum levels of aspartate aminotransferase (AST), lactic acid dehydrogenase (LDH), creatine kinase (CK), and creatine kinase-MB isozyme (CK-MB) were detected. Additionally, cardiac function indices including SV, LVDD, CO, LVEF in these patients were recorded before the operation and 6 days after operation.@*Results@#Compared with those before the operation, the levels of serum enzymes were all significantly increased after unclamping the aorta. The levels of serum AST, LDH and CK reached their peak 24 h after unclamping the aorta. Notably, the levels of serum AST, LDH and CK in the experimental group were lower than those in the control group at each time point after unclamping the aorta (P < 0.05). For serum CK-MB, the level in both the two groups reached its peak 6 h after unclamping the aorta. The level of CK-MB in the experimental group was significantly decreased compared with that in the control group 6, 24 and 72 h after unclamping the aorta (P < 0.05). Moreover, there were no significant differences in cardiac function indices between the 2 groups before the operation (P > 0.05). The levels of SV, CO and LVEF in the experimental group were significantly increased while the level of LVDD was obviously decreased compared to that in the control group after the operation, SV: (70.93 ± 9.72) ml vs. (65.07 ± 6.81) ml, CO: (5.32 ± 0.98) L vs. (4.29 ± 0.91) L, LVEF: (57.87 ± 8.92)% vs. (52.68 ± 7.31)% and LVDD: (55.67 ± 4.12) mm vs. (62.85 ± 5.71) mm, and there were statistical differences (P < 0.05).@*Conclusions@#Calcium dibutyryladenosine cyclophosphate has protective effects on myocardial ischemia-reperfusion injury and cardiac function in patients undergoing CABG operation under CPB, by reducing serum levels of myocardial enzymes in these patients.
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The inflammatory reaction induced by ischemic myocardial injury (IMI) is divided into three phases, i．e. the inflammatory phase, the fibrous proliferative phase and the stable phase. The appropriate inflammatory reaction effectively removes the fragments of myocardial cells, which is the essential phase in the pathological progression of myocardial ischemia (MI). However, the excessive inflammatory reaction may aggravate the myocardial injury. For this reason, the immediate control of the post-injury inflammatory reaction is the principal therapeutic measure and the research hotspot at the present. Acupuncture intervention has been demonstrated to have positive roles in relieving MI and inflammatory reaction by suppressing myocardial inflammatory cytokines (suppressing IL-1β， TNF-α， IL-8, etc.), adjusting inflammatory reaction pathway (NF-κB signaling, TGF-β， etc.)and activating cholinergic anti-inflammatory pathway. Therefore, it is feasible to explore the underlying mechanism of acupuncture therapy in protecting ischemic myocardium based on anti-inflammatory efficacy.
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Objective: The objective of the study is to compare the myocardial protective effects of isoflurane with propofol in patients undergoing elective coronary artery bypass surgery on cardiopulmonary bypass (CPB), the cardio protection been assessed by changes in N-terminal brain natriuretic peptide (NT proBNP). Methodology and Design: This study is designed as a participant blinded, prospective randomized clinical trial. Setting: Christian Medical College Hospital, Vellore, India. Participants: Patients undergoing elective coronary artery bypass surgery on CPB. Intervention: Anesthesia was maintained with 0.8–1.2 end tidal concentrations of isoflurane in the isoflurane group and in the propofol group, anesthesia was maintained with propofol infusion as described by Roberts et al. Measurements: Hemodynamic data were recorded at frequent intervals during the surgery and up to 24 h in the Intensive Care Unit (ICU). The other variables that were measured include duration of mechanical ventilation, dose and duration of inotropes in ICU, (inotrope score), duration of ICU stay, NT proBNP levels before induction and 24 h postoperatively, creatine kinase-MB levels in the immediate postoperative, first and second day. Results: Mean heart rate was significantly higher in propofol group during sternotomy, (P = 0.021). Propofol group had a significantly more number of patients requiring nitroglycerine in the prebypass period (P = 0.01). The increase in NT proBNP from preoperative to postoperative value was lesser in the isoflurane group compared to propofol even though the difference was not statistically significant. The requirement of phenylephrine to maintain mean arterial pressure within 20% of baseline, mechanical ventilation duration, inotrope use, duration of ICU stay and hospital stay were found to be similar in both groups. Conclusion: Propofol exhibit comparable myocardial protective effect like that of isoflurane in patients undergoing coronary artery bypass graft surgery. Considering the unproven mortality benefit of isoflurane and the improved awareness of green OT concept, propofol may be the ideal alternative to volatile anesthetics, at least in patients with good left ventricular function.
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@#Objective To analyze the effect of myocardial protection between modified Del Nido cardioplegia and St. Thomas Hospital Cardioplegia in adult patients with aortic valve and mitral valve replacement. Methods From January 2014 to June 2016, 140 patients underwent aortic valve and mitral valve replacement in our hospital. According to different cardioplegia, the patients were divided into two groups including a modified Del Nido cardioplegia group (70 patients, 37 males, 33 females at mean age of 53.13±9.52 years) and a St. Thomas cardioplegia group (70 patients, 32 males, 38 females, at age of 50.71±9.29 years). We collected clinical data of the patients before operation (T1), 2 h after aortic unclamping (T2), 24 h after operation (T3) and 48 h after operation (T4). Indexes of muscle enzymes including blood center creatine kinase (CK), creatine kinase isoenzyme (CK-MB) concentration and liver function indexes including urea nitrogen (BUN), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST) concentrations, and compared the postoperative and follow-up clinical data. Results There was no statistical difference in age, weight, gender, ejection fraction baseline data between the two groups (P>0.05). All patients were successfully completed combined valve replacement under cardiopulmonary bypass. The cardiopulmonary time was no statistical difference between the two groups (P>0.05). However, compared with St. Thomas cardioplegia group, modified Del Nido group was less in perfusion (1.19±0.39 vs. 2.99±0.75, P<0.001), shorter in aortic clamping time (P=0.003). No statistical difference was found in defibrillation rate after resuscitation between the two groups (P=0.779). Biochemical indicators were not statistically different at different time points between the two groups (P>0.05). Conclusion Modified Del Nido cardioplegia has the same effect on myocardial protection with St. Thomas cardioplegia in adult patients. It reduces the frequency of reperfusion, and shortens the clamping time. There is no additional injury in the important organs such as liver, kidney. Modified Del Nido cardioplegia myocardial protection ability in adult heart valve surgery is feasible.
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Objective To observe the efficacy of Shenfu Yangrong Decoction combined with routine Western therapy in the treatment of viral myocarditis (VMC) of Ⅰ– Ⅲ grades in children. Methods Totally 100 cases of VMC children were selected and divided into observation group and control group according to random number table method, with 50 cases in both groups. The control group was treated with routine Western therapy, while the observation group was combined with Shenfu Yangrong Decoction based on the control group, one dosage a day, twice a day, orally. The TCM syndrome scores, the serum levels of interleukin (IL)-17, IL-27 and nuclear factor - κB (NF-κB), the levevs of troponin Ⅰ (cTnⅠ) and cardiac free fatty acid binding protein (H-FABP) before and after treatment in both groups were compared, and the total incidence of adverse reactions during treatment was monitored. Results The total effective rate was 90% (45/50) in the observation group and 74% (37/50) in the control group. The observation group was significantly higher than the control group (χ2=4.336, P=0.037). Compared with before treatment, the scores of the main symptoms, the scores of the secondary symptoms, and the total scores of the two groups decreased significantly after treatment (P＜0.01). Comparing the two groups after treatment, the scores of main symptoms, scores of secondary symptoms and total scores of the observation group were significantly lower than those of the control group (P＜0.05, P＜0.01). Compared with before treatment, serum IL-17, NF-κB, cTnⅠ, H-FABP levels were significantly reduced (P＜0.01), while serum IL-27 levels were significantly increased (P＜0.01) in both group. After treatment, the levels of serum IL-17, NF-κB, cTnⅠ, and H-FABP in the observation group were significantly lower than those in the control group (P＜0.01), and serum IL-27 level in the observation group was significantly higher than in the control group (P＜0.01). The adverse reaction rate was 12% (6/50) in the observation group and 8% (4/50) in the control group, without statistical significance between the two groups (χ2=0.368, P=0.544). Conclusion Shenfu Yangrong Decoction combined with routine Western therapy for the treatment of viral myocarditis children of Ⅰ– Ⅲ grades can effectively reduce the symptoms of patients, inhibit inflammation, reduce myocardial injury, with high safety.
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Objective To observe the effects of remote ischemic preconditioning(RIPC) on Na+-K+-ATP enzyme and Ca2+-Mg2+-ATP enzyme in thoracoscopic heart operation.Methods One hundred and twenty patients with thoracoscopic heart operation were randomly divided into the thoracoscopic extracorporeal circulation control group (C)and RIPC plus thoracoscopic extracorporeal circulation group(RIPC).The acidity and alkalinity change of arterial blood before and after treatment was abserved in the RIPC group;the changes of myocardial enzymes spectrum,cTnI and oxidation indicators(SOD,MDA) were compared among different time periods,and preoperative and postoperative Na+-K+-ATP enzyme and Ca2+-Mg2+-ATP enzyme levels were also compared.Results Compared with the group C,the acidity and alkalinity of artery blood were lower after RIPC(P＜0.05);the levels of CK-MB and cTnI at postoperative 6,24 h in the RIPC group were lower than those in those in the group C(P＜0.05);the SOD activity was higher than that in the group C,while the MDA level was lower than that in the group C(P＜0.05);the postoperative Na+-K+-ATP enzyme and Ca2+-Mg2+-ATP enzyme levels were higher than those in the group C at different degrees.Conclusion RIPC can alleviate myocardial injury in the patients with thoracoscopic heart operation and this effect may be related with activation of corresponding ATP enzyme.
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Objective To study the effect of erythropoietin( EPO) pretreatment on myocardial pro-tection in perioperative period of infant congenital heart disease operation and explore its underlying mecha-nism. Methods All the 80 patients who were suffered from non-cyanotic congenital heart disease undergone cardiopulmonary bypass in open heart operation were selected from Shengjing Hospital of China Medical Uni-versity cardiac surgery ward from April 2014 to January 2017. The patients were randomly divided into A,B, C three groups according to blocked randomization method. Group A patients were treated with subcutaneous injection of EPO 150 IU/kg 12 hours before operation,group B patients were treated with subcutaneous injec-tion of EPO 300 IU/kg 12 hours before operation,patients in group C( control group) had no treatment. All patients were detected myocardial zymetology after admission to hospital as well as 24 h,48 h,72 h after oper-ation. HSP70,ERK1/2 mRNA and protein expression in right auricle were detected by qRT-PCR and Western blot method,respectively. Results At each time point after operation,myocardial zymetology were signifi-cantly lower in group A and B compared with group C,the index of myocardial zymetology in group A were lower than that in group B(P<0. 05). The expressions of HSP70,ERK1/2 mRNA and protein were signifi-cantly up-regulated in group A and B compared to the control group(P<0. 05). The expressions of HSP70, ERK1/2 mRNA and protein in group A were significantly higher than those in group B ( P < 0. 05 ) . Conclusion EPO pretreatment has a positive effect on the myocardial protection during cardiopulmonary bypass. EPO may act a role of endogenous myocardial protection through up-regulation of the expressions of HSP70 and ERK1/2. The dosage of 150 IU/kg EPO is more significant on the effect of myocardial protection.
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@#Objective To investigate the myocardial protective effects of Del Nido cardioplegia and analyze its advantages in adult cardiac surgery. Methods We retrospectively analyzed the clinical data of 96 adult patients undergoing cardiac valve surgery who received Del Nido cardioplegia (a DNC group) from June 2016 to January 2017 in our hospital. There were 44 males and 52 females with a mean age of 51.36±13.31 years. Meanwhile 96 patients who received conventional cardioplegia were recruited as a control group (a CTC group) and there were 53 males and 43 females with a mean age of 52.91±10.95 years. Cross-clamping time, cardiopulmonary bypass (CPB) time, total volume of and transfusion frequency of cardioplegia, the rate of spontaneous defibrillation, red blood cell transfusion and vasoactiveinotropic score at postoperative 24 hours (VIS 24) were recorded. Results No significant difference was found in age, body weight, ejection fraction, hematokrit, CPB time and cross-clamping time between the DNC group and CTC group. There was no significant difference in the rate of spontaneous defibrillation, VIS 24, cardiac enzymes and cardiactroponinI and length of ICU stay between the two groups. The total volume and transfusion frequency of cardioplegia, perioperative blood transfusion were lower in the DNC group. There was no new atrial fibrillation or in-hospital death in the two groups. Conclusion Del Nido is a good myocardial protection solution in adult cardiac valve surgery, and requires less static preload volume and reduces hemodilution and perioperative blood transfusion.