RESUMO
The study examined effectiveness of pharmaco-cold cardioplegia employing solutions of enhanced buffer capacity during surgery of obstructive hypertrophic cardiomyopathy in adult patients (N=51) operated during 2013-2018. In group 1 (N=28), the cardioplegia was performed with HTK (Custodiol) solution, whereas in group 2 (N=23), it was carried out with Bokeria-Boldyrev ACH solution. The mean, minimum, and maximum ages in group 1 were 46, 21, and 64 years, respectively; in group 2 - 42, 14, and 70 years, respectively. In both groups, the patients were subjected to myoectomy of exit pathway in the left ventricle according to Bokeria-Morrow operation and annuloplasty of tricuspid valve accompanied by reconstructive surgery (or replacement) of mitral valve. Atrial fibrillation (if any) was suppressed with cryoablation (-60°Ð¡) of the openings of the right and left pulmonary veins. The surgery was carried out in hypothermic mode at 28°C. The significant intergroup differences were observed in the asystole latent period after the onset of antegrade or retrograde injection of cardioplegic solution. In group 1, the asystole latent periods determined after antegrade or retrograde injection were 53±7 or 170±30 sec, respectively; in group 2 - 32±6 and 97±11 sec (p<0.0001), respectively. The mean times of aortic cross-clumping in groups 1 and 2 were 66±8 and 64±6 min, respectively; the electromechanical action of the heart restored after aortic unclamping in 35±7 and 30±6 sec, respectively. The biochemical and clinical data revealed no significant intergroup differences. Overall, novel Bokeria-Boldyrev ACH cardioplegic solution secured effective protection of the myocardium against intraoperative ischemia in adult patients with obstructive hypertrophic cardiomyopathy and significantly decreased the asystole latent period.
Assuntos
Cardiomiopatia Hipertrófica/cirurgia , Adulto , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/cirurgia , Cardiomiopatia Hipertrófica/tratamento farmacológico , Feminino , Glucose/uso terapêutico , Parada Cardíaca Induzida , Humanos , Masculino , Manitol/uso terapêutico , Pessoa de Meia-Idade , Cloreto de Potássio/uso terapêutico , Procaína/uso terapêutico , Adulto JovemRESUMO
The cardioprotective effect of cardioplegic solution based on histidine-containing dipeptides was evaluated on isolated rat heart under conditions of hyporthermia and long ischemia. The use of natural dipeptides in cardioplegic solutions promoted an increase in the buffer capacity of myocardial cells and creation of an additional anti-ischemic effect under conditions of long ischemia and hypothermia.
Assuntos
Cardiotônicos/farmacologia , Dipeptídeos/farmacologia , Animais , Soluções Cardioplégicas/farmacologia , Carnosina/análogos & derivados , Carnosina/farmacologia , Temperatura Baixa , Hipotermia Induzida , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/metabolismo , Ratos , Ratos WistarRESUMO
The paper presents the first results of therapeutic angiogenesis in clinical cardiosurgery: human VEGF(165) gene transplantation to coronary patients. The use of this therapeutic method is particularly effective in patients with inoperable cardiovascular injuries, i.e. patients with the most severe condition, in whom treatment remains little effective at the modern level of cardiosurgery development.
