RESUMO
OBJECTIVES: The optimal myocardial protective solution in the neonatal arterial switch operation remains controversial. The aim of this study was to demonstrate that Bretschneider's histidine-tryptophan-ketoglutarate crystalloid solution (Custodiol) offers protection at least similar to that of cold blood cardioplegia. METHODS: Patients who underwent the neonatal arterial switch operation with Custodiol between January 2016 and December 2018 (n = 23) were compared with an historical cohort from August 2010 to December 2015 in which cold blood cardioplegia was used (n = 41). A linear mixed-effect model for repeated measures was performed to test the recovery of myocardial function based on inotropic and vasoactive inotropic scores, cardiac enzyme release and left ventricular ejection fraction. RESULTS: Patients in the cold blood cardioplegia group had higher inotropic scores in the first 24 h (0 h, P = 0.001 and 24 h, P = 0.006) and higher vasoactive inotropic scores in the first 72 h (0 h, 24 h and 48 h, P < 0.001; 72 h, P = 0.012). Cardiac troponin-I concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-72 (1 h, 6 h, 12 h and 24 h, P < 0.001; 48 h, P = 0.001 and 72 h, P = 0.003). Creatinine-kinase-MB concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-24 (1 h, 6 h and 12 h, P < 0.001; 24 h, P = 0.042). The left ventricular ejection fraction was higher in the Custodiol group just after the operation (P = 0.005), at 24 h (P = 0.001) and on the first day without inotropic support (P = 0.011). CONCLUSIONS: Neonatal myocardium protected with Custodiol during the arterial switch operation presented optimal ventricular function recovery with less inotropic support and less myocardial damage compared with cold blood cardioplegia.
Assuntos
Transposição das Grandes Artérias/métodos , Parada Cardíaca Induzida/métodos , Miocárdio/metabolismo , Transposição dos Grandes Vasos/cirurgia , Soluções Cardioplégicas/farmacologia , Feminino , Glucose/farmacologia , Humanos , Recém-Nascido , Masculino , Manitol/farmacologia , Cloreto de Potássio/farmacologia , Procaína/farmacologia , Transposição dos Grandes Vasos/sangue , Troponina I/sangue , Função Ventricular Esquerda/efeitos dos fármacosRESUMO
Se hace un estudio retrospectivo de las historias clínicas de 19 pacientes que presentaban afecciones funcionales o tumorales de la glándula suprarrenal, a los cuales se les realizaron 22 intervenciones sobre la glándula. La enfermedad de Cushing fue la causa más frecuente de las intervenciones y el feocromocitoma la segunda. Las principales complicaciones transoperatorias estuvieron relacionadas con los aspectos funcionales de la glándula de acuerdo con la enfermedad: hipertensión o hipotensión arterial. La vía de acceso utilizada estuvo relacionada con la enfermedad y la localización. Se utilizó la vía anterior fundamentalmente en las afecciones localizadas en el lado izquierdo y la posterior en las del lado derecho(AU)
