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大动脉置换后的乳酸脱酶水平:它们告诉我们什么?

Laura Rings^1,2, Loreta Mavrova-Risteska¹, Achim Haeussler^1,2

¹Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.

The Thoracic and cardiovascular surgeon

|November 1, 2024

概括

乳酸脱酶 (LDH) 可能不会表明在动脉置换 (AVR) 以无门之后发生血解. 升高的LDH可能反映了心肌活动,而不是对膜泄漏 (PVL).

科学领域:

心血管外科心血管外科
生物标志物生物标志物
医疗器械医疗器械

背景情况:

乳酸脱酶 (LDH) 是大动脉置换 (AVR) 后血液溶解的常见术后标志物.
以前的研究表明,微粒和AVR后升高的LDH之间存在联系.
在无AVR中LDH的作用需要进一步研究,特别是在跨吸管大动脉门 (TA-TAVs) 和快速部署门 (RDVs) 中.

研究的目的:

分析在接受TA-TAV或RDV的AVR患者中LDH水平的术后相关性.
调查LDH,对膜泄漏 (PVL) 和不同无门类型的血液溶解之间的关联.
在现代AVR技术的背景下,确定LDH是否是血液溶解或其他现象的可靠指标.

主要方法:

对138名在2015年至2018年期间接受RDV或TA-TAV的AVR患者的回顾性分析.
两组患者手术前和手术后对准漏 (PVL) 和LDH水平进行比较.
评估跨膜梯度,需要植入心脏起器的心脏阻塞和30天死亡率.

主要成果:

与RDV组 (n=79) 相比,TA-TAV组 (n=59) 年龄较大,PVL发病率较高.
尽管PVL比率较高,但TA-TAV组的LDH水平较低;RDV组中的Perceval趋向于更高的LDH.
与TA-TAV组相比,RDV组有更多的心律失常,但与TA-TAV组相比,30天死亡率相似,心脏起器植入率较低.

结论:

这项研究不支持血液溶解和PVL之间的直接关联,而PVL是由无门中LDH升高所表明的.
无AVR后LDH升高可能意味着心肌输出增加或门动,不一定是血液溶解.
研究结果表明,在先进的大动脉置换技术的背景下,重新评估LDH作为血液溶解的唯一标志物.

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