Cold blood cardioplegia reduces the increase in cardiac enzyme levels compared with cold crystalloid cardioplegia in patients undergoing aortic valve replacement for isolated aortic stenosis

Braathen, Bjørn; Tønnessen, Theis

doi:10.1016/j.jtcvs.2009.05.036

Cited by 45 publications

(33 citation statements)

References 24 publications

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“…In literature there are little data comparing warm blood and CCC in the aortic valve replacement surgery. Braathen and Tønnessen in 80 patients undergoing isolated aortic valve replacement showed a better myocardial protection with the use of cold blood cardioplegia in comparison with CCC (20). In contrast to the observed value of CK-MB in our study that was less than 20 ng/mL at 24 PO hours in the CCC group, they found a CK-MB value greater than 45 micrograms (mcg)/L at 20 PO hours with the use of the CCC.…”

Section: Discussioncontrasting

confidence: 94%

“…Interestingly, the mean value of cTnI at 24 and 48 hours reported using cold and WBC was similar to that observed in our study in the CCC group and in the WBC group, respectively. However, although the reported study and other studies have underlined some different degree of myocardial protection in favor of one or of the another type of cardioplegia, no differences have been observed in terms of perioperative myocardial infarction, low output cardiac syndrome, PO non-cardiac major complications, and death (12,(20)(21)(22)(23). These findings are in accordance with those observed in our study: in fact, although the release of cardiac enzymes was in favor of CCC, the perioperative outcome was similar in both groups of patients.…”

Section: Discussionmentioning

confidence: 64%

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Cold crystalloid versus warm blood cardioplegia in patients undergoing aortic valve replacement

et al. 2018

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Background: Myocardial protection techniques during cardiac arrest have been extensively investigated in the clinical setting of coronary revascularization. Fewer studies have been carried out of patients affected by left ventricular hypertrophy, where the choice of type and temperature of cardioplegia remain controversial.We have retrospectively investigated myocardial injury and short-term outcome in patients undergoing aortic valve replacement plus or minus coronary artery bypass grafting with using cold crystalloid cardioplegia (CCC) or warm blood cardioplegia (WBC). Methods: From January 2015 to October 2016, 191 consecutive patients underwent aortic valve replacement plus or minus coronary artery bypass grafting in normothermic cardiopulmonary bypass.Cardiac arrest was obtained with use of intermittent antegrade CCC group (n=32) or WBC group (n=159), according with the choice of the surgeon. Results: As compared with WBC group, in CCC group creatine-kinase-MB (CK-MB), cardiac troponin I (cTnI), aspartate aminotransferase (AST) release, and their peak levels, were lower during each time points of evaluation, with the greater statistically significant difference at time 0 (P<0.05, for all comparisons). A time 0, CK-MB/CK ratio >10% was 5.9% in CCC group versus 7.8% in WBC group (P<0.0001). At time 0 CK-MB/CK ratio >10% in patients undergoing isolated aortic valve replacement was 6.0% in CCC group versus 8.0% in WBC group (P<0.01). No any difference was found in perioperative myocardial infarction (0% versus 3.8%), postoperative (PO) major complications (15.6% versus 16.4%), in-hospital mortality (3.1% versus 1.3%). Conclusions: In aortic valve surgery a significant decrease of myocardial enzymes release is observed in favor of CCC, but this difference does not translate into different clinical outcome. However, this study suggests that in presence of cardiac surgical conditions associated with significant left ventricular hypertrophy, i.e., the aortic valve disease, a better myocardial protection can be achieved with the use of a cold rather than a warm cardioplegia. Therefore, CCC can be still safely used.

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Section: Discussioncontrasting

confidence: 94%

Section: Discussionmentioning

confidence: 64%

Cold crystalloid versus warm blood cardioplegia in patients undergoing aortic valve replacement

et al. 2018

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“…These mean postprocedural cardiac marker levels are comparable with those reported after TAVI (with transfemoral and transapical approach) with the Edwards SAPIEN (Edwards Lifesciences Inc; Irvine, CA) device. 32 The values of postprocedural markers are remarkably low compared with those found after surgical valve replacement and CABG 14,19,20,33,34 and higher compared with those after PCI. 9,12,15,17,18 The absence of aortic cross-clamping and cardioplegia in combination with less direct myocardial trauma could explain the relatively lower biomarker levels after TAVI compared with cardiac surgery.…”

Section: Discussionmentioning

confidence: 97%

Predictors and Prognostic Value of Myocardial Injury During Transcatheter Aortic Valve Implantation

Yong

Wiegerinck

Dijk

et al. 2012

Circ: Cardiovascular Interventions

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Background-Myocardial injury is a common complication during cardiac surgery and percutaneous coronary intervention and is associated with postprocedural cardiovascular morbidity and mortality. Limited data have been reported about the occurrence of myocardial damage associated with transcatheter aortic valve implantation (TAVI). Therefore, our purpose was to investigate the incidence, predictors, and prognostic value of myocardial injury during TAVI. Methods and Results-We studied 119 patients (aged 81Ϯ8 years; 47 male) who had undergone a TAVI with the Medtronic-CoreValve bioprosthesis. Serum creatine kinase-MB (CK-MB) and cardiac troponin T (cTnT) levels were measured before and after the procedure. Myocardial injury was defined as a postprocedural increase of CK-MB and/or cTnT level Ͼ5 times the upper reference limit. After TAVI, the incidence of myocardial injury was 17%, which was independently predicted by procedural duration (in minutes) (odds ratio

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“…Histidine has a buffer effect and may enhance the efficiency of anaerobic glycolysis, tryptophane stabilizes the cell membrane and the addition of mannitol decreases cellular oedema, whereas ketoglutarate is a precursor of nicotinamide adenine dinucleotide (6). Several studies have demonstrated the efficacy of the HTK solution based on biochemical markers or physiological evaluation in experimental models (7)(8)(9). HTK solution helps to preserve myocardial adenosine triphosphate stores, improve post-arrest contractile function and minimize myocardial necrosis (10,11).…”

Section: Introductionmentioning

confidence: 99%

Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution

Lin

Xiang-wei

Tang

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Cardioplegic reperfusion during a long-term ischemic period interrupts cardiac surgery and increases cellular edema due to repeated administration. The present clinical study compared the protective effects of histidine-ketoglutarate-tryptophan (HTK) solution and St. Thomas crystalloid cardioplegia. Clinical experiences of the myocardial protection induced by one single perfusion with HTK were reviewed in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease. This retrospective study included 88 high-risk patients (aortic cross-clamp time, >120 min) between March 2001 and July 2012. The cohort was divided into two groups according to the technique used. Either myocardial protection was performed with one single perfusion with HTK solution (HTK group) or with conventional St. Thomas crystalloid cardioplegia (St group). The duration of cardiopulmonary bypass did not differ between the two groups. The mortality, morbidity, intensive care unit (ICU) stay, postoperative hospitalization, and transfusions of HTK group are significantly lower than those of the St group (P<0.05). Univariate and multivariate analysis demonstrated that HTK is a statistically significant independent predictor of decreased early mortality and morbidity (P<0.05). In conclusion, the present findings suggested that HTK solution decreases mortality, morbidity, ICU stay, postoperative hospitalization, and transfusions in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease.

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Cold blood cardioplegia reduces the increase in cardiac enzyme levels compared with cold crystalloid cardioplegia in patients undergoing aortic valve replacement for isolated aortic stenosis

Abstract: Antegrade cold blood cardioplegia provides better myocardial protection than cold crystalloid cardioplegia in patients undergoing aortic valve replacement.

Cited by 45 publications

References 24 publications

Cold crystalloid versus warm blood cardioplegia in patients undergoing aortic valve replacement

Cold crystalloid versus warm blood cardioplegia in patients undergoing aortic valve replacement

Predictors and Prognostic Value of Myocardial Injury During Transcatheter Aortic Valve Implantation

Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution

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