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The interval time for the St. Thomas cardioplegia solution in mitral valve surgeries
Sitong Tang1, Na Chen2, Jiajun Zhong1
1Wenzhou Medical University, Wenzhou, China.
Insights
A cardioplegia interval exceeding 30 minutes during mitral valve surgery increases the risk of myocardial damage, as indicated by higher creatine kinase-MB levels. Shorter intervals are associated with better outcomes, suggesting a need for optimized timing in cardiac procedures.
Area of Science:
- Cardiac Surgery
- Cardiology
- Biochemistry
Background:
- Lack of consensus exists regarding optimal St. Thomas cardioplegia solution intervals in cardiac surgeries.
- Determining a safe cardioplegia interval is crucial for patient outcomes.
Purpose of the Study:
- To investigate the association between cardioplegia interval duration and myocardial damage markers post-mitral valve surgery.
- To identify a safe threshold for cardioplegia interval in St. Thomas solution use.
Main Methods:
- 340 patients undergoing mitral valve surgery with St. Thomas solution were analyzed.
- Patients were divided into two groups based on a 30-minute cardioplegia interval threshold.
- Propensity score matching was employed to control for confounding variables, resulting in 125 patients per group.
Main Results:
- Postoperative creatine kinase-MB (CK-MB) mass levels were significantly higher in the group with cardioplegia intervals greater than 30 minutes (Group B) compared to the group with intervals less than or equal to 30 minutes (Group A).
- Threshold effect analysis indicated that intervals exceeding 27.6 minutes were associated with increased CK-MB mass, with a risk elevation noted above 31 minutes at 7 hours post-surgery.
- No other significant differences in primary endpoints were observed between the groups.
Conclusions:
- Cardioplegia intervals exceeding 30 minutes in St. Thomas solution are linked to increased myocardial damage risk during mitral valve surgery.
- Further research is warranted to explore the relationship between cardioplegia interval duration and other myocardial injury markers.
Background:
There is a lack of consensus on the appropriate St. Thomas cardioplegia solution interval for cardiac surgeries. The objective of this study was to determine a safe cardioplegia interval.
Method:
A total of 340 patients who underwent mitral valve surgery with St. Thomas solution were assessed and divided into 2 groups according to the average cardioplegia interval. In Group A, the average cardioplegia interval was < = 30 min; in Group B, the average cardioplegia interval was greater than 30 min. Propensity score matching was used to adjust for confounders between the two groups. After propensity score matching, Groups A and B contained 125 patients each. The primary endpoints were creatine kinase MB, left ventricular ejection fraction, and troponin levels after surgery. Threshold effect analysis was used to assess the association of the cardioplegia interval with the postoperative CK-MB mass level.
Results:
After propensity score matching, postoperative CK-MB mass significantly differed between the two groups, and CK-MB levels were significantly greater in group B than in group A(Group A vs. Group B: 46.1 [46.1;48.3] ng/ml vs. 49.9 [46.1;62.7] ng/ml, p < 0.001). According to the threshold effect analysis, the interval needs to be above 27.6 min before it is associated with an increased risk of CK-MB mass level, and the interval needs to be above 31 min before it is associated with an increased risk of CK-MB mass level 7 h after surgery. There were no other significant differences between the two groups.
Conclusions:
The multidose cardioplegia interval above 30 min during mitral valve surgery is associated with a greater risk of myocardial damage. The relationships between the cardioplegia interval and other myocardial markers require further research.
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