| Objective:We retrospectively analyzed and compared the safety and efficacy of HTK cardioplegia and del Nido cardioplegia in double-valve replacement surgery in our Hospital,and evaluated the myocardial protective effect and advantages of HTK cardioplegia and del Nido cardioplegia.Method:A total of 125 patients who underwent double-valve replacement under cardiopulmonary bypass(CPB)in our Hospital,from January 2019 to November 2022 were.Among them,57 patients who used HTK cardioplegia were in the HTK group,aged 58.00(52.50,64.75)years,38(55.90%)males,and the remaining 68 patients who used del Nido cardioplegia were in the DN group,aged 56.00(50.00,63.50)years,25(43.90%)males.Perioperative clinical data were collected and compared between the two groups in terms of CPB time,blocking time,perfusion volume,perfusion times,cardiac shock recovery,duration of mechanical ventilation,postoperative ICU stay,postoperative hospital stay and complications;myocardial injury markers high-sensitivity troponin(hs-c Tn T),creatine kinase isoenzyme(CK-MB),myoglobin(Mb),N-terminal pro-B-type natriuretic peptide(NT-pro BNP)levels in blood were collected at24 h,48h and 72 h after operation;measurement data were analyzed by t-test or non-parametric test(Mann-Whitney U test),enumeration data were analyzed by chi-square test(x~2)and Fish exact test in the two groups.Results:There was no significant difference in height,weight,sex composition,age distribution,hypertension,diabetes,smoking history and preoperative atrial fibrillation between the two groups(P>0.05).There was no significant difference in LVEF,left ventricular systolic membrane meridian,left ventricular end diastolic diameter and serum levels of hs-c Tn T,CK-MB,Mb and NT-pro BNP between the two groups(P>0.05).In terms of blocking time [154.50(134.50,177.00)min in DN group,160.00(142.50,179.50)min in HTK group,P=0.634],and CPB time [209.0(186.25,237.25)min in DN group,214.00(191.50,245.00)in HTK group,P=0.406],there was no significant statistical difference between the two groups in this study;There were more perfusion times in DN group compared with HTK group,with statistical difference(2.17±0.38 in DN group,1.05±0.23 in HTK group,P<0.001),and there were fewer DN groups in terms of cardioplegia dosage,with statistical difference [1800.00(1500.00,2000.00)ml in DN group,2000.00(2000.00,2000.00)ml in HTK group,P<0.001].In this study,there was no significant difference in operation time(383.04±83.98 min in DN group,400.33±92.55 min in HTK group,P=0.276)and mechanical ventilation time [39.00(23.00,57.25)h in DN group,42.00(24.00,70.00)h in HTK group,P=0.237];ICU length of stay [67.00(43.00,97.63)h in DN group,73.00(44.00,118.50)h in HTK group,P=0.302] and postoperative length of stay [14.00(11.00,19.25)d in DN group,12.00(10.00,16.00)d in HTK group,P=0.054].In terms of the second operation(2 cases in DN group,n=68;0 case in HTK group,n=57;P=0.500),there was no significant statistical difference between the two groups in this study;In terms of tracheotomy(5 cases in DN group,n=68;3 cases in HTK group,n=57;P=0.726),there was no significant statistical difference between the two groups in this study;There was no statistical difference between the two groups in terms of postoperative acute lung injury,acute kidney injury,poor incision healing,postoperative arrhythmia and the use of ECMO and IABP(P>0.05).In terms of postoperative death,3patients in the DN group(n=68)and 3 patients in the HTK group(n=57;P=1.000),1 patient in the HTK group had heart failure,2 patients had multiple organ failure,and 3 patients in the DN group had cardiac arrest,low cardiac output syndrome,and multiple organ failure.Serum hs-c Tn T concentrations(pg/ml)at24 hours after surgery in the two groups were: 1089.00(655.45,2000.00)vs 1259.00(736.05,2321.00),(P=0.367),hs-c Tn T concentrations(pg/ml)at 48 hours after surgery: 924.50(618.75,1745.75)vs 977.90(713.95,2058.00),(P=0.258),serum hs-c Tn T concentrations(pg/ml)at 72 hours after surgery: 689.45(458.65,1417.00)vs 876.00(561.85,1419.00),(P=0.126),and there was also no statistically significant difference in the other serological parameters Mb,CK-MB,and NT-pro BNP(P>0.05).One month after operation,there was no significant difference in atrial flutter,atrial fibrillation,left ventricular ejection fraction,left ventricular end systolic diameter and left ventricular end diastolic diameter between the two groups(P>0.05).Conclusion:Del Nido cardioplegia can achieve the same myocardial protective effect as HTK cardioplegia in double-valve replacement from the evaluation of high-sensitivity troponin and other markers of myocardial injury,and del Nido perfusion patients have more advantages in spontaneous heart rate recovery than HTK cardioplegia,which can provide safe and reliable myocardial protection for patients undergoing double-valve replacement. |
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