Clinical efficacy of epicardial application of drug-releasing hydrogels to prevent postoperative atrial fibrillation
Clinical efficacy of epicardial application of drug-releasing hydrogels to prevent postoperative atrial fibrillation
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DOI：
10.1016/j.jtcvs.2015.06.061
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发表时间：
2016-01-01
影响因子：
6
通讯作者：
Feng, Xiao Dong
中科院分区：
文献类型：
--
作者：
Wang, William;Mei, Yun Qing;Feng, Xiao Dong
目的：术后心房颤动是心脏手术后最常见的并发症，发生率为40%。心外膜胺碘酮/皮质类固醇水凝胶给药治疗术后心房颤动可提高疗效，减少副作用。为了进一步评估胺碘酮水凝胶是否优于皮质类固醇水凝胶或安慰剂，我们对150例冠状动脉旁路移植术患者进行了随机前瞻性研究，比较术后不同心外膜药物入路的有效性。方法：将2012年1月至2014年7月间行心脏手术的患者150例，经机构审查委员会批准，随机分为3组。I组采用胺碘酮聚基水凝胶，II组采用曲安奈德聚基水凝胶。两种水凝胶弥漫性喷淋在双心房心外膜上。对照组只进行水凝胶喷雾治疗。术后持续遥测监测心房颤动，术后测量心房、血浆和组织中的胺碘酮或曲安奈德酮水平。每天测量心电图参数，直至术后第14天。结果：I组术后房颤发生率明显降低，50例患者中有4例（8%）发生房颤，II组为11例（22%），对照组为13例（26%），差异有统计学意义（P < 0.01）。心房内胺碘酮和曲安奈德酮平均浓度（12.06 +/- 3.1/1.5 +/- 0.7）显著高于心外组织（1.32 +/- 0.9/0.2 +/- 0.4,P < 0.01）。血浆胺碘酮及曲安奈德含量仍低于检出限(
Objective: Postoperative atrial fibrillation is the most frequent complication arising after cardiac surgery, occurring in 40% of cases. The treatment of postoperative atrial fibrillation with epicardial amiodarone/corticosteroid hydrogel delivery can increase efficacy and reduce side effects. To further evaluate whether amiodarone hydrogel is superior to corticosteroid hydrogel or placebo, we performed a randomized prospective study in 150 patients with coronary artery bypass grafting to compare the effectiveness with different epicardial drug approaches in the postoperative period.Methods: After institutional review board approval, 150 patients, from January 2012 to July 2014, who had undergone cardiac surgery were randomized to 3 equal groups. Group I received poly-based hydrogel with amiodarone, and group II received poly-based hydrogel with triamcinolone. Both hydrogels were sprayed diffusely over the biatrial epicardium. The control group underwent the procedure with only hydrogel spray. Continuous telemetry monitored for postoperative atrial fibrillation, and amiodarone or triamcinolone levels in the atria, plasma, and tissue were measured postoperatively. Daily electrocardiographic parameters were measured until postoperative day 14.Results: The incidence of postoperative atrial fibrillation was significantly less in group I, with 4 of 50 patients (8%) incurring atrial fibrillation compared with 11 of 50 patients (22%) in group II and 13 of 50 patients (26%) in the control group (P < .01). The mean amiodarone and triamcinolone concentrations in the atria (12.06 +/- 3.1/1.5 +/- 0.7) were significantly greater than those in the extracardiac tissues (1.32 +/- 0.9/0.2 +/- 0.4; P < .01). The plasma amiodarone and triamcinolone levels remained below the detection limit (