Clinical Outcomes of Nitroglycerin Perfusion via the Aortic Root before Heart Re-beating for Patients Undergoing Heart Valve Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Shengyu , ZHAO Tiefu , WANG Rong , CHEN Hong , ZHANG Chunxiao.

Department 　of Cardiac Surgery， Beijing Anzhen Hospital， Capital Medical University， Beijing 100029， P. R. China;

Corresponding author：

Keywords：

Heart valve replacement; 　Myocardial protection; 　Nitroglycerin

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Abstract： Objective To explore clinical outcomes of nitroglycerin perfusion via the aortic root before heart re-beating　 for patients undergoing heart valve replacement. Methods A total of 254 patients with valvular heart diseases underwent　 heart valve replacement in Beijing Anzhen Hospital from January 2008 to December 2011. According to whether or not they received nitroglycerin perfusion via the aortic root before heart re-beating during cardiopulmonary bypass （CPB）， all the 254 patients were randomly divided into two groups， the nitroglycerin group and the control group. There were 134 patients　 in the nitroglycerin group including 57 males and 77 females with their average age of 58.47±12.34 years. They received aortic root perfusion of 5 mg nitroglycerin diluted into 20 ml after full de-airing of the heart， and repeated aspiration was performed 8 to 10 times before heart re-beating during CPB. Aortic cross-clamp was released after the heart showed signs of automatic re-beating， and the aortic root was squeezed in high frequency by hand to make sure that the aorta was squeezed to close each time. In the control group， there were 120 patients including 64 males and 56 females with their average　 age of 61.85±11.97 years. Patients in the control group received routine procedures of CPB except nitroglycerin perfusion before heart re-beating. Automatic heart re-beating rate， CPB supporting time after heart re-beating， postoperative usage of inotropic drugs， mechanical ventilation time， perioperative morbidity and length of hospital stay were compared between the 2 groups， and patients were followed up and further evaluated. Results There was no in-hospital death. CPB supporting time after heart re-beating（12.32±9.76 min vs. 23.43±10.33 min， t=-1.233， P=0.000）， dopamine usage［3.45±2.33 μg/ （kg?min） vs. 5.67±3.12 μg/ （kg?min）， t=-0.943 ， P=0.034］ and epinephrine usage ［0.026±0.013 μg/ （kg?min） vs. 0.056±0.021 μg/ （kg?min）， t=-0.822 ， P=0.027］ of the nitroglycerin group were significantly shorter or lower than those of the control group. Automatic heart re-beating rate of the nitroglycerin group was significantly higher than that of the control group ［97.01% vs. 66.67 % ， χ 2 =-2.115 ， P=0.000］. A total of 121 patients in the nitroglycerin group were followed up for 2-36 months， and 13 patients were lost during follow-up. There was no death during follow-up.　 Conclusion For patients undergoing heart valve replacement， some myocardial protection strategies including nitroglycerin　 perfusion via the aortic root before heart re-beating， use of norepinephrine， and aortic root squeezing in high frequency by hand can significantly increase the automatic heart re-beating rate， shorten the CPB supporting time after heart re-beating， and improve postoperative clinical outcomes.

Citation： WANG Shengyu,ZHAO Tiefu,WANG Rong,CHEN Hong,ZHANG Chunxiao.. Clinical Outcomes of Nitroglycerin Perfusion via the Aortic Root before Heart Re-beating for Patients Undergoing Heart Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(1): 29-32. doi: Copy

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5.	解少强，吴远林，杨朝坤，等. 心脏瓣膜病外科治疗267例. 中国胸心血管外科临床杂志， 2012， 19 （1）：105.
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17.	Li S， Price R， Phiroz D， et al. Systemic inflammatory response during　 cardiopulmonary bypass and strategies. J Extra Corpor Technol， 2005， 37 （2）：180-188.
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19.	Kaminski KA， Bonda TA， Korecki J， et al. Oxidative stress and neutrophil activation--the two keystones of ischemia/reperfusion　 injury. Int J Cardiol， 2002， 86 （1）：41-59.
20.	孙忠东，高尚志，王志维，等. 蛋白激酶C在未成熟心肌预处理中的作用. 中国胸心血管外科临床杂志， 2010， 17 （5）：395-398.
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23.	Li L， Watanabe Y， Matsuoka I， et al. Acidic preconditioning　 inhibits Na + /H+ and Na + /Ca 2+ exchanger interaction via PKCepsilon in guinea-pig ventricular myocytes. J Pharmacol Sci， 2008， 107 （3）：309-316.
24.	Budas GR. Churchill EN， Mochly-Rosen D. Cardioprotective mechanism s of PKC isozyme-s elective activators and inhibit ors in the treatment of ischem a-reperfusion injury.Pharmacol Res， 2007， 55 （6）：523-536.

1. 　李佳春，李功宋，主编. 体外循环灌注学. 北京：人民军医出版社， 1993. 107.
2. 　刘洪端，刘立明. 缺血后处理的研究进展. 中国胸心血管外科临床杂志， 2012， 19 （3）：309-313.
3. 　Hall RI， Smith MS， Rocker G. The systemic inflammatory response to cardiopulmonary bypass：pathophysiological， therapeutic， and pharmacological considerations. Anesth Analg， 1997， 85 （4）：766-782.
4. 　杨磊. 脑钠肽的生物学意义与临床价值. 临床合理用药杂志， 2010， 3 （3）：125-126.
5. 　解少强，吴远林，杨朝坤，等. 心脏瓣膜病外科治疗267例. 中国胸心血管外科临床杂志， 2012， 19 （1）：105.
6. 　陈林，肖颖彬，肖娟，等. 不同心肌保护方法在双瓣膜置换术中对心肌的保护作用. 中国胸心血管外科临床杂志， 2012， 19 （4）：371-375.
7. 　王辉山，汪曾炜，朱洪玉，等. 老年患者二尖瓣置换同期行冠状动脉旁路移植术的临床分析. 中国胸心血管外科临床杂志， 2008， 15 （3）：222-224.
8. 　龙村，主编. 体外循环手册. 北京：人民卫生出版社， 2005. 374-378.
9. 　李佳春，李功宗. 体外循环灌注学. 北京：人民军医出版社， 1993.389-390.
10. 　徐美英，于布为. 重症风心病二尖瓣主动脉置换加三尖瓣成形术的麻醉处理. 第二军医大学学报， 1994， 15 （1）：69-71.
11. 　赖应龙，魏蜀亮，邓志刚，等. 经冠状静脉窦持续低流量逆行灌注在双瓣膜置换术中的应用. 中国胸心血管外科临床杂志， 2009， 16 （3）：232-233.
12. 　Katircioglu SF， Cicekcioglu F， Parlar AI， et al. A new technique of myocardial protection during aortic root replacement：antegrade/retrograde coronary perfusion. Thorac Cardiovasc Surg， 2007， 55 （4）：259-261.
13. 　龚庆成，主编. 体外循环技术指导. 北京：人民军医出版社， 2005. 141， 304.
14. 　Nordlie MA， Wold LE， Simkhovich BZ， et al. Molecular aspects of ischemic heart disease：ischemia/reperfusion-induced genetic changes and potential applications of gene and RNA interference therapy. J Cardiovasc Pharmacol Ther， 2006， 11 （1）：17-30.
15. 　Ulus AT， Aksoyek A， Ozkan M， et al. Cardiopulmonary bypass as a cause of free radical-induced oxidative stress and enhanced blood-borne isoprostanes in humans. Free Radic Biol Med， 2003， 34 （7）：911-917.
16. 　Iskesen I， Kurdal AT， Kahraman N， et al. Preoperative oral pentoxifylline for management of cytokine reactions in cardiac surgery. Heart Surg Forum， 2009， 12 （2）：E100-E104.
17. 　Li S， Price R， Phiroz D， et al. Systemic inflammatory response during　 cardiopulmonary bypass and strategies. J Extra Corpor Technol， 2005， 37 （2）：180-188.
18. 　Zhao ZQ. Oxidative stress-elicited myocardial apoptosis during　 reperfusion. Curr Opin Pharmacol， 2004， 4 （2）：159-165.
19. 　Kaminski KA， Bonda TA， Korecki J， et al. Oxidative stress and neutrophil activation--the two keystones of ischemia/reperfusion　 injury. Int J Cardiol， 2002， 86 （1）：41-59.
20. 　孙忠东，高尚志，王志维，等. 蛋白激酶C在未成熟心肌预处理中的作用. 中国胸心血管外科临床杂志， 2010， 17 （5）：395-398.
21. 　Molnár A， Borbély A， Czuriga D， et al. Protein kinase C contributes to the maintenance of contractile force in human ventricular　 cardiomyocytes. J Biol Chem， 2009， 284 （2）：1031-1039.
22. 　Wang JZ， Cai CY， Zhang YM， et al. N-n-Butyl haloperidol iodide protects against hypoxia/reoxygenation-induced cardiomyocyte injury by modulating protein kinase C activity. Biochem Pharmacol， 2010， 79 （10）：1428-1436.
23. 　Li L， Watanabe Y， Matsuoka I， et al. Acidic preconditioning　 inhibits Na + /H+ and Na + /Ca 2+ exchanger interaction via PKCepsilon in guinea-pig ventricular myocytes. J Pharmacol Sci， 2008， 107 （3）：309-316.
24. 　Budas GR. Churchill EN， Mochly-Rosen D. Cardioprotective mechanism s of PKC isozyme-s elective activators and inhibit ors in the treatment of ischem a-reperfusion injury.Pharmacol Res， 2007， 55 （6）：523-536.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Outcomes of Nitroglycerin Perfusion via the Aortic Root before Heart Re-beating for Patients Undergoing Heart Valve Replacement

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