Poređenje Custodiol®-a i modifikovane St. Thomas kardioplegije u zaštiti miokarda tokom operacije aortokoronarnog premošćavanja

  • Dragan Cvetković Clinic for Cardiac Surgery Clinical Centre of Serbia
  • Mladen Kočica Clinic for Cardiac Surgery Clinical Centre of Serbia
  • Ljiljana Šoškić Clinic for Cardiac Surgery Clinical Centre of Serbia
  • Filip Vučićević Clinic for Cardiac Surgery Clinical Centre of Serbia
  • Olga Petrović Clinic for Cardiology Clinical Centre of Serbia
  • Ivana Jovanović Clinic for Cardiology Clinical Centre of Serbia
  • Snežana Jovičić Center for Medical Biochemistry Clinical Centre of Serbia
  • Jelena Trifković Faculty of Chemistry, University of Belgrade
  • Saša Kostovski Clinic for Cardiac Surgery Clinical Centre of Serbia
  • Biljana Miličić Faculty of Dentistry, University of Belgrade
  • Milica Karadžić Clinic for Cardiac Surgery Clinical Centre of Serbia
  • Arsen Ristić Clinic for Cardiology Clinical Centre of Serbia
  • Dragutin Savić Pacemaker Center Clinical Centre of Serbia
DOI: https://doi.org/10.2298/VSP181108192C
Ključne reči: srce, izazvani zastoj;, custodiol-n rastvor;, hirurgija, kardijalna, procedure;, postoperativni priod;, aritmija;, srce, funkcijski testovi;, mortalitet

Sažetak


Uvod/Cilj. Custodiol® je hiperpolarizirajući kardioplegični rastvor koji je korišćen u našoj nacionalnoj kardiohirurškoj praksi isključivo u transplantacionoj hirurgiji. Zbog svojih brojnih prednosti u odnosu na standardne depolarizirajuće rastvore, Custodiol® je, u mnogim kardiohirurškim centrima, postao kardioplegični rastvor izbora za sve kardiohirurške procedure. Cilj studije bio je procena zaštite miokarda rastvorom Custodiol® u poređenju sa modifikovanom St. Thomas kardioplegičinim rastvorom u koronarnoj hirurgiji. Metode. Tokom prospektivne četveromesečne studije, 110 uzastopnih odraslih bolesnika podvrgnutih primarnoj, izolovanoj, elektivnoj operaciji aortokoronarnog premošćavanja bili su randomizirani na osnovu primenjene kardioplegije u Custodiol® grupu (n = 54) i St. Thomas grupu (n = 50); šest bolesnika je bilo isključeno iz studije. Zaštita miokarda izvršena je primenom antegradne, hladne kristaloidne kardioplegije jednim od rastvora, a procenjena je praćenjem sledećih parametara: spontane uspostave srčanog ritma nakon deklemovanja; vrednosti kardiospecifičnih enzima; promene ejekcione frakcije (EF) 24 sata nakon operacije; učestalosti postoperativne inotropne potpore, infarkta miokarda (MI), atrijalne fibrilacije (AF) i smrti. Rezultati. Preoperativne i intraoperativne karakteristike bolesnika bile su slične u obe grupe, osim značajno dužeg vremena klemovanja u Custodiol® grupi (49,1 ± 19,0 min. vs. 41,0 ± 12,9 min; p = 0,022). Custodiol® grupa, u odnosu na St. Thomas grupu, imala je češću spontanu uspostavu srčanog ritma (31,5% vs. 20,0%, p = 0,267), uz nižu učestalost AF (20,4% vs. 28%, p = 0,496), MI (1,8% vs. 10,0%, p = 0,075) i inotropne podrške (9,0% vs. 12,0%, p = 0,651), ali bez statističke značajnosti. Maksimalne vrednosti troponina I (5,0 ± 3,92 µg/L vs. 4,5 ± 3,39 µg/L; p = 0,755) i kreatin kinaze-MB (26,9 ± 15,4 µg/L vs. 28,5 ± 24,2 µg/L; p = 0,646) bile su slične, šest sati nakon operacije. U obe došlo je do je sličnog smanjenja EF (0,81% vs. 1,26%; p = 0,891) bez mortaliteta unutar 30 dana nakon operacije. Zaključak. Custodiol ima sličan kardioprotektivni efekat u poređenju sa modifikovanim St. Thomas kardioplegičnim rastvorom kod operacije aortokoronarnog premošćavanja. Zbog dužeg vremena klemovanja aorte, uz istovremeni trend manje učestalosti MI, AF i inotropne podrške u grupi sa rastvorom Custadiol®, studija na većem broju bolesnika mogla bi otkriti prednosti Custadiol®-a u zaštiti miokarda tokom operacije aortokoronarnog premošćavanja.

Reference

Malbouisson LM, Santos LM, Auler JO Jr, Carmona MJ. Myo-cardial protection in cardiac surgery. Rev Bras Anestesiol 2005; 55(5): 558‒74. (Portuguese)

Gunnes S, Jynge P. Fundamentals of the Past: Cardioplegia: The First Period Revisited. In: Podesser BK, Chambers DJ, edi-tors. New Solutions for the Heart. Wien: Springer-Verlag; 2011. p.15‒40.

Veljović M, Popadić A, Vukić Z, Ilić R, Trifunović Z, Antunović M, et al. Myocardial protection during elective coronary artery bypasses grafting by pretreatment with omega-3 polyun-saturated fatty acids. Vojnosanit Pregl 2013; 70(5): 484‒92.

Angeli E, Lueck S, Gargiulo GD. Different strategies of myo-cardial protection: the age of perfectionism. J Thorac Dis 2018; 10(3): 1211‒3.

Preusse CJ. Custodiol cardioplegia: a single dose hyperpolar-izing solution. J Extra Corpor Technol 2016; 48(2): P15‒P20.

Thielmann M, Sharma V, Al-Attar N, Bulluck H, Bisleri G, Bunge JJH, et al. ESC Joint Working Groups on Cardiovas-cular Surgery and the Cellular Biology of the Heart Posi-tion Paper: Peri-operative myocardial injury and infarction in patients undergoing coronary artery bypass graft sur-gery. Eur Heart J 2017; 38(31): 2392‒407.

Januzzi JL Jr. Troponin Testing After Cardiac Surgery. HSR Proc Intensive Care Cardiovasc Anesth 2009; 1(3): 22‒32.

Onorati F, De Feo M, Mastroroberto P, Cristodoro L, Pezzo F, Ren-zulli A, et al. Determinants and prognosis of myocardial damage after coronary artery bypass grafting. Ann Thorac Surg 2005; 79(3): 837‒45.

Dézsi CA. Trimetazidine in Practice: Review of the Clinical and Experimental Evidence. Am J Ther 2016; 23(3): e871‒9.

Edelman JJ, Seco M, Dunne B, Matzelle SJ, Murphy M, Joshi P, et al. Custodiol for myocardial protection and preservation: a systematic review. Ann Cardiothorac Surg 2013; 2(6): 717‒28.

Elwatidy AM , Fadalah MA, Bukhari EA, Aljubair KA, Syed A, Ashmeg AK, et al. Antegrade crystalloid cardioplegia vs an-tegrade/retrograde cold and tepid blood cardioplegia in CABG. Ann Thorac Surg 1999; 68(2): 447‒53.

Arslan A, Sezgin A, Gultekin B, Ozkan S, Akay T, Uguz E, et al. Low-Dose Histidine-Tryptophan-Ketoglutarate Solution for Myocardial Protection. Transplant Proc 2005;37(7): 3219‒22.

Demmy TL, Molina JE, Ward HB, Gorton ME, Kouchoukos NT, Schmaltz RA, et al. Custodiol versus Plegisol: A phase 3 mul-ticentre myocardial protection study. Int J Angiol 2008; 17(3): 149‒53.

Hamed MA, Abdel-Ghaffar RA. Comparative Study between Three Solutions for Cardioplegia in Pediatric Cardiac Sur-gery: Histidine-Tryptophan-Ketoglutarate (HTK) Solution, Blood Cardioplegia and Crystalloid (St. Thomas) Cardio-plegia. J Anesth Clin Res 2018; 9(4): 818.

Careaga G1, Salazar D, Téllez S, Sánchez O, Borrayo G, Argüero R. Clinical impact of histidine-ketoglutarate-tryptophan (HTK) cardioplegic solution on the perioperative period in open heart surgery patients. Arch Med Res 2001; 32(4): 296‒9.

Lin YZ , Huang JB , Li XW , Tang XM , Lu WJ , Wen ZK , et al. Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardiople-gia: A 12-year study from a single institution. Exp Ther Med 2017; 14(3): 2677‒82.

Holmvang L, Jurlander B, Rasmussen C, Thiis JJ, Grande P, Clemmensen P. Use of biochemical markers of infarction for diagnosing perioperative myocardial infarction and early graft occlusion after coronary artery bypass surgery. Chest 2002; 121(1): 103‒11.

Benoit MO, Paris M, Silleran J, Fiemeyer A, Moatti N. Cardiac troponin I: its contribution to the diagnosis of perioperative myocardial infarction and various complications of cardiac surgery. Crit Care Med 2001; 29(10): 1880‒6.

Croal BL, Hillis GS, Gibson PH, Fazal MT, El-Shafei H, Gibson G, et al. Relationship between postoperative cardiac tro-ponin I levels and outcome of cardiac surgery. Circulation 2006; 114(14): 1468‒75.

Objavljeno
2020/12/08
Broj časopisa
Vol. 77 Br. 11 (2020): Vojnosanitetski pregled
Rubrika
Originalni članak