Myocardial Protection Reseach Of Avr With Beating-heat On Severe As With Left Ventricular Hypertrophy

For a long time,there is a high risk and high mortality for the heartfunction is poorer, especially myocardial hypertrophy of cardiacpatients.Most scholars believe that the operation process of myocardialprotection become the key to success or failure[1].Has a large number ofexperimental and clinical study that it is a kind of effective method for heartmyocardial protection during operation with cold liquid crystal heart cardiacarrest and light to moderate temperature cardiopulmonary bypass(CPB),And has been applied to routine for many medicalinstitutions.However,As a result of the surgery process inevitably onmyocardial Ischemia reperfusion injury,especially for big heart and poorheart function and Intraoperative blocking aorta patients for a longertime.The rate of low cardiac output syndrome and severe arrhythmia afterthe operation increased significantly,It is the leading cause of death inpatients with postoperative[2].Domestic and foreign scholars have beenalways constantly looking for better ways of myocardialprotection.1980s,They gradually began to adopt the new method ofprotection,the method is doing operation without aortic cross clamp and without application of cardioplegia but In vitro circulation on beating heartcondition, Had obtained the ideal effect of myocardial protection.But therestill is not a clinical comparative study of about poor cardiac functionand myocardial fat in surgical operation center in myocardialprotection.We want to use the comparative study method throughsevere aortic stenosis in patients with left ventricular hypertrophy anduse the retrograde perfusion without cardiac arrest and cardiac arresttreatment and we will statistical analysis of the relevant indexes of twogroups of patients and the healing situation in this subject.Objective To investigate and evaluate the effect of myocardialprotection of Aortic valve replacement (AVR) with beating-heart on severeAS with left ventricular hypertrophy.Method To Choice46Patients in theFirst Affiliated Hospital of Guangxi Medical University operation treatmentof aortic stenosis (AS) and patients with left ventricular hypertrophy during2011January to2013December,Were randomly divided into treatmentgroup and control group,The treatment group of29cases among them,andwith beating-heart method protection.And the control group of17casesamong them,and with the method of cardiac arrest.Treatment related indexand the statistics of two groups of patients, Draw blood from the vein In thefollowing times: T1(before CPB)、 T2(Aortic occlusion30minutes)、T3(open the aorta30minutes)、T4(open the aorta1hours)、T5(postoperative6hours) and T6(postoperative24hours) to testing the Serum concentration ofTroponin I and other myocardial enzyme（Myocardial enzyme,ME）.ResultThere is no significant differences(P>0.05) in the operation times,CPB andpostoperative drainage through the result comparison two groups ofpatients.But there is significant differences(P＜0.05)In dopamine usage and ICU stay time.3patients died after operation,1cases withoutcardioplegia group,2patients cardiac arrest group.And Without cardioplegiagroup does not appear serious low cardiac output syndrome,but2patients oflow cardiac output syndrome from arrest group.2patients withpostoperative renal dysfunction from the off-pump group,1patients fromarrest group.Two groups of superoxide dismutase (SOD) in serumconcentration after CPB than before operation were significantly higher(P＜0.01),and it was obviously increased in the off-pump group. But nosignificant difference was found between the two groups（P>0.05）.TheSerum concentration of two groups of malondialdehyde (MDA), lactatedehydrogenase (LDH), cardiac troponin I (Troponin I), creatine kinase (CK)and creatine kinase isoenzyme (CK-MB) at T2(Aortic occlusion30minutes),T3(open the aorta30minutes),T4(open the aorta1hours),T5(postoperative6hours) and T6(postoperative24hours)declining,But stillhigher than before CPB (P<0.01),And the heart keeps jumping group wassignificantly lower than that of serum concentration of cardiac arrest group(P<0.01).Conclusion It is better mothed for myocardial protection by usingthe method of retrograde perfusion for AVR with beating-heart on severe ASwith left ventricular hypertrophy,and it is better for clinical.