ABSTRACT
Objective To summary and explore the indications,safety and effectiveness of no touch ostial cardioplegia delivery method during aortic valve replacement(AVR) for severe aortic insufficiency(AI),in order to provide guidance for clinical application.Methods Between September 2012 and February 2015,63 cases were randomly divided into two groups,in study group we used this technique in 31 patients with a mean age of(58.0 ± 15.0) years and a range of 31 to 74 years old.The degree of AI averaged (3.5 ± 0.5) according to a semiquantitative 5-grade scale[1].32 patients were enrolled in control group with a mean age of(60.4 ± 9.4) years and a range of 22 to 73 years old.The degree of AI averaged (3.6 ± 0.5).The abnormal aortic cusps were sutured though the aortic incision,which would be closed temporarily.Blood cardioplegia was infused repeatedly into the coronary osita through the closed aortic incision during the remainder of the procedure except AVR,when the closed aortic incision was reopened.Results In the study group,spontaneous resumption of nodal and normal sinus rhythm shortly after the removal of aortic cross-clamp was achieved in all patients,no hearts had to be electrically defibrillated and electrocardiogram showed no obvious S-T segment elevation.The time from cross-clamp removal to sinus rhythm was(12.3 ± 7.7) minutes in the study group,versus (18.6 ± 8.2) minutes in the control group(P =0.037).No operative mortality occurred in both groups.There was a significant increase in left ventricular ejection fraction[from(0.54 ± 0.09) preoperatively to(0.62 ± 0.06) postoperatively] (P =0.005) in patients of the study group,which was not seen in patients of the control group.Conclusion Preliminary results have shown that the no touch ostial cardioplegia delivery method is a feasible method for cardioplegia infusion during aortic valve replacement in patients with severe AI.