Objective: To explore the efficacy of myocardial protection with single-dose histidine-tryptophan-ketoglutarate (HTK) cardioplegia during aortic root operation, and the correlation between short-term clinical outcomes and duration of myocardial ischemia. Methods: The data of clinical cases undergoing myocardial protection with single-dose HTK cardioplegia during aortic root operation from January 2018 to December 2022 were retrospectively reviewed. Patients were divided into conventional HTK cardioplegia group (<3 h) and prolonged HTK cardioplegia group (≥3 h) according to duration of intraoperative myocardial ischemia. A 1∶1 propensity score matching was performed and the correlations between duration of myocardial ischemia and postoperative short-term outcomes (30-day mortality, readmission, mechanical circulation support and renal insufficiency) were analyzed. Results: A total of 282 patients were included in the final analysis, with 210 cases in the conventional HTK cardioplegia group and 72 cases inthe prolonged HTK cardioplegia group before matching. After matching, there were 64 cases (53 males and 11 females) in the conventional HTK cardioplegia group, with a mean age of (49.4±14.2) years. The prolonged HTK cardioplegia group had 64 cases (55 males and 9 females), with a mean age of (50.5±12.3) years. Higher sensitivity troponin [12 h: 10.1 (4.6, 18.7) μg/Lvs 4.1(2.2, 8.6) μg/L, P=0.002; 24 h: 7.7 (4.5, 19.0) μg/L vs 4.8 (2.2, 11.9) μg/L, P=0.025] and creatine kinase isoenzyme[12 h: 46.3 (28.1, 62.4) μg/L vs 20.7(14.1, 32.9) μg/L, P<0.001; 24 h: 26.3(13.4, 49.2) μg/L vs 14.5 (10.1, 33.5)μg/L, P=0.011] after surgery was detected in prolonged HTK cardioplegia group. Comparisons of other primary and secondary endpoint events showed no significant differences between the two groups (all P>0.05). Multivariate binary logistic regression showed that duration of myocardial ischemia had no significant effect on postoperative 30-day mortality (OR=1.255, 95%CI: 0.500-3.148, P=0.629), 30-day readmission (OR=0.378, 95%CI: 0.069-2.065, P=0.261) and mechanical circulation support (OR=0.991, 95%CI: 0.331-2.970, P=0.998). Conclusion: During aortic root surgery, single-dose HTK cardioplegia may provide satisfactory myocardial protection, and there was no significant correlation between duration of myocardial ischemia and short-term clinical outcomes.
目的： 探讨主动脉根部手术不同心肌缺血时间单次灌注组氨酸-色氨酸-酮戊二酸（HTK）液的心肌保护效果及对短期临床预后的影响。 方法： 回顾性分析2018年1月至2022年12月云南省阜外心血管病医院主动脉根部手术中采用单次HTK液灌注实施心肌保护的患者资料，根据不同心肌缺血时间分为常规HTK灌注组（心肌缺血时间<3 h）和超长HTK灌注组（心肌缺血时间≥3 h），采用倾向性评分进行1∶1匹配，分析不同心肌缺血时间条件下的心肌保护效果及缺血时间与术后终点事件（术后30 d内死亡率、再次住院率、机械辅助、术后肾功能不全）的相关性。 结果： 纳入282例患者，匹配前常规HTK灌注组210例，超长HTK灌注组72例。匹配后常规HTK灌注组64例，年龄（49.4±14.2）岁，其中男53例，女11例；超长HTK灌注组64例，年龄（50.5±12.3）岁，其中男55例，女9例。与常规HTK灌注组比较，超长HTK灌注组术后12 h和24 h高敏肌钙蛋白［10.1（4.6，18.7）比4.1（2.2，8.6）μg/L，P=0.002；7.7（4.5，19.0）比4.8（2.2，11.9）μg/L，P=0.025］和肌酸激酶同工酶［46.3（28.1，62.4）比20.7（14.1，32.9）μg/L，P<0.001；26.3（13.4，49.2）比14.5（10.1，33.5）μg/L，P=0.011］均较高。其余各项终点事件比较，两组间差异均无统计学意义（均P>0.05）。多因素logistic回归分析结果显示，心肌缺血时间与术后30 d内死亡（OR=1.255，95%CI：0.500~3.148，P=0.629）、30 d内再住院（OR=0.378，95%CI：0.069~2.065，P=0.261）、机械循环支持（OR=0.991，95%CI：0.331~2.970，P=0.998）无明显关联。 结论： 在主动脉根部手术中，采用单次灌注HTK液可以提供较好的心肌保护效果，心肌缺血时间与临床主要短期预后无明显相关性。.