Title : Myocardial protection for combined mitral-aortic-tricuspid valve correction: Is retrograde applying of cardioplegia is better?
Abstract:
Objective: To present analysis of retrograde crystalloid cardioplegia during combined valve pathology of mitral-aortic-tricuspid valve disease (matvd) .
Materials and Methods: During 2009-2023 yy 529 patients (pts) with (MATVD) were operated in Institute by CPB. There were 243 (45,9%) males, 286 (54,1%) females. Average age was 60,4±8,2 yy. NYHA class in all group were followings: II class – 28 (5,4%), III class – 229 (43,3%), IV class – 272 (51,3%) pts. Double valve replacement+ TV`s plasty (n=389), MVR + AV`s plasty + TV`s plasty (n=38), MAR + MV`s plasty + TV`s plasty (n=102). Concomitant procedures: resection of left atrium`s auriculum (n=155), LA`s plasty (n=67), Maze (n=92). The following applying of cardioplegia (Custadiol) were performed by: antegrade 84 (15,8%) pts (group A), ante-retrograde 66 (12,5%) pts (group B), retrograde – 379 (71,7%) pts (group C) ways.
Systemic hypothermia 32-34 C, cardiopulmonary bypass, retrograde cardioplegic solution (Custadiol) (in dose 20 ml/kg) + external cooling of myocardium were occured in all pts. Average time of improvement of cardioplegia solution (min) were for: group A - 9,8±0,9, group B - 12,8±1,5, group C - 20,2±2,7 (p<0,05). Average cross-clamping time (min) were for: group A - 69,8±7,9, group B - 64,8±7,5, group C - 52,7±6,4 (p<0,05) and reperfusion time (min) was for group A - 19,8±3,3, group B - 18,6±3,1, group C - 16,1±2,5(p >0,05).
Results. Hospital mortality was for group A 3,5% (n=3/84). , group B - 3,0% (n=2/66)., group C - 1,1% (n=4/379) (p<0,05). Average doses of dobutamin (1,0-3,0 mcrg/min/kg) were marked for: group A - 54,8±7,2 hours, group B - 49,1±5,7 hours, group C - 41,5±5,4 hours (p <0,05). Average level of MB KFK (U/L) at 2-td postoperative day were occured for: group A - 87,3±9,1, group B - 79,4±8,6, group C - 69,1±7,4 (p <0,05). Duration of stay on artificial lung ventilation (hours) were: group A - 8,7±0,9, group B - 8,1±0,7, group C - 7,5±0,5 (p>0,05). Average time of staying in intensive care unit (hours) were: group A - 59,2±7,5, group B - 53,3±6,4, group C - 45,7±5,3 (p <0,05). Absence of applying donor blood product during all postoperative period for group A - 65,5%, group B - 68,3%, group C - 72,6% (p<0,05).
Conclusion. Improved myocardial protection in cases with MATVD by using retrograde crystalloid cardioplegic solution (Custadiol) (group C) lead to better results than in group A and B (p<0,05).
