Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis
Background: Hypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic stenosis. Methods: This retrospective study included 225 consecutive patien...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Society for Thoracic and Cardiovascular Surgery
2015-06-01
|
| Series: | Korean Journal of Thoracic and Cardiovascular Surgery |
| Subjects: | |
| Online Access: | http://www.kjtcvs.org/journal/download_pdf.php?doi=10.5090/kjtcs.2015.48.3.164 |
| _version_ | 1811228213159919616 |
|---|---|
| author | Jung Hee Lee Dong Seop Jeong Kiick Sung Wook Sung Kim Young Tak Lee Pyo Won Park |
| author_facet | Jung Hee Lee Dong Seop Jeong Kiick Sung Wook Sung Kim Young Tak Lee Pyo Won Park |
| author_sort | Jung Hee Lee |
| collection | DOAJ |
| description | Background: Hypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare
the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic
stenosis. Methods: This retrospective study included 225 consecutive patients (mean age, 65±10 years; 123
males) with severe aortic stenosis who underwent aortic valve replacement. Patients were excluded if they had coronary
artery disease, an ejection fraction ＜50%, more than mild aortic regurgitation, or endocarditis. The patients
were divided into three groups: group A, which was treated with antegrade and retrograde cold blood cardioplegia;
group B, which was treated with antegrade crystalloid cardioplegia using histidine-tryptophan-ketoglutarate (HTK) solution;
and group C, treated with retrograde cold blood cardioplegia. Results: Group A contained 70 patients
(31.1%), group B contained 74 patients (32.9%), and group C contained 81 patients (36%). The three groups
showed significant differences with regard to the proportion of patients with a New York Heart Association functional
classification ≥III (p=0.035), N-terminal pro-brain natriuretic peptide levels (p=0.042), ejection fraction (p=0.035), left
ventricular dimensions (p＜0.001), left ventricular mass index (p＜0.001), and right ventricular systolic pressure (p
＜0.001). Differences in cardiopulmonary bypass time (p=0.532) and aortic cross-clamp time (p=0.48) among the
three groups were not statistically significant. During postoperative recovery, no significant differences were found
regarding the use of inotropes (p=0.328), mechanical support (n=0), arrhythmias (atrial fibrillation, p=0.347; non-sustained
ventricular tachycardia, p=0.1), and ventilator support time (p=0.162). No operative mortality occurred.
Similarly, no significant differences were found in long-term outcomes. Conclusion: Although the three groups
showed some significant differences with regard to patient characteristics, both antegrade crystalloid cardioplegia
with HTK solution and retrograde cold blood cardioplegia led to early and late clinical results similar to those achieved
with combined antegrade and retrograde cold blood cardioplegia. |
| first_indexed | 2024-04-12T09:54:26Z |
| format | Article |
| id | doaj.art-8bef47cbcbde486b930fe1733f130268 |
| institution | Directory Open Access Journal |
| issn | 2233-601X 2093-6516 |
| language | English |
| last_indexed | 2024-04-12T09:54:26Z |
| publishDate | 2015-06-01 |
| publisher | Korean Society for Thoracic and Cardiovascular Surgery |
| record_format | Article |
| series | Korean Journal of Thoracic and Cardiovascular Surgery |
| spelling | doaj.art-8bef47cbcbde486b930fe1733f1302682022-12-22T03:37:45ZengKorean Society for Thoracic and Cardiovascular SurgeryKorean Journal of Thoracic and Cardiovascular Surgery2233-601X2093-65162015-06-0148316417310.5090/kjtcs.2015.48.3.164Clinical Results of Different Myocardial Protection Techniques in Aortic StenosisJung Hee Lee0Dong Seop Jeong1Kiick Sung2Wook Sung Kim3Young Tak Lee4Pyo Won Park5Samsung Medical CenterSamsung Medical CenterSamsung Medical CenterSamsung Medical CenterSamsung Medical CenterSamsung Medical CenterBackground: Hypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic stenosis. Methods: This retrospective study included 225 consecutive patients (mean age, 65±10 years; 123 males) with severe aortic stenosis who underwent aortic valve replacement. Patients were excluded if they had coronary artery disease, an ejection fraction ＜50%, more than mild aortic regurgitation, or endocarditis. The patients were divided into three groups: group A, which was treated with antegrade and retrograde cold blood cardioplegia; group B, which was treated with antegrade crystalloid cardioplegia using histidine-tryptophan-ketoglutarate (HTK) solution; and group C, treated with retrograde cold blood cardioplegia. Results: Group A contained 70 patients (31.1%), group B contained 74 patients (32.9%), and group C contained 81 patients (36%). The three groups showed significant differences with regard to the proportion of patients with a New York Heart Association functional classification ≥III (p=0.035), N-terminal pro-brain natriuretic peptide levels (p=0.042), ejection fraction (p=0.035), left ventricular dimensions (p＜0.001), left ventricular mass index (p＜0.001), and right ventricular systolic pressure (p ＜0.001). Differences in cardiopulmonary bypass time (p=0.532) and aortic cross-clamp time (p=0.48) among the three groups were not statistically significant. During postoperative recovery, no significant differences were found regarding the use of inotropes (p=0.328), mechanical support (n=0), arrhythmias (atrial fibrillation, p=0.347; non-sustained ventricular tachycardia, p=0.1), and ventilator support time (p=0.162). No operative mortality occurred. Similarly, no significant differences were found in long-term outcomes. Conclusion: Although the three groups showed some significant differences with regard to patient characteristics, both antegrade crystalloid cardioplegia with HTK solution and retrograde cold blood cardioplegia led to early and late clinical results similar to those achieved with combined antegrade and retrograde cold blood cardioplegia.http://www.kjtcvs.org/journal/download_pdf.php?doi=10.5090/kjtcs.2015.48.3.164Aortic valveReplacementMyocardial reperfusion injuryCardioplegic solutionsRetrograde |
| spellingShingle | Jung Hee Lee Dong Seop Jeong Kiick Sung Wook Sung Kim Young Tak Lee Pyo Won Park Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis Korean Journal of Thoracic and Cardiovascular Surgery Aortic valve Replacement Myocardial reperfusion injury Cardioplegic solutions Retrograde |
| title | Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis |
| title_full | Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis |
| title_fullStr | Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis |
| title_full_unstemmed | Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis |
| title_short | Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis |
| title_sort | clinical results of different myocardial protection techniques in aortic stenosis |
| topic | Aortic valve Replacement Myocardial reperfusion injury Cardioplegic solutions Retrograde |
| url | http://www.kjtcvs.org/journal/download_pdf.php?doi=10.5090/kjtcs.2015.48.3.164 |
| work_keys_str_mv | AT jungheelee clinicalresultsofdifferentmyocardialprotectiontechniquesinaorticstenosis AT dongseopjeong clinicalresultsofdifferentmyocardialprotectiontechniquesinaorticstenosis AT kiicksung clinicalresultsofdifferentmyocardialprotectiontechniquesinaorticstenosis AT wooksungkim clinicalresultsofdifferentmyocardialprotectiontechniquesinaorticstenosis AT youngtaklee clinicalresultsofdifferentmyocardialprotectiontechniquesinaorticstenosis AT pyowonpark clinicalresultsofdifferentmyocardialprotectiontechniquesinaorticstenosis |