Comparison of heat monitoring-based myocardial protection strategy with classic myocardial protection method in isolated coronary artery bypass surgery patients

Gojayev, Farid; Solgun, Huseyin Avni; Ak, Koray; Mıdı, Ahmet; Canillioglu, Yasemin

doi:10.1016/j.carpath.2019.107161

Cited by 1 publication

(2 citation statements)

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“…Moreover, advances in minimally invasive cardiac surgery make crystalloid solutions more popular as they offer to allow prolonged uninterrupted surgery. 12 Until recently, although many studies are comparing cold HTK with IBC (either cold or tepid), the patients enrolled into have remained heterogeneous (acutely ischemic, valvular, or complex combined pathologies) and the parameters included in the analyses are quite variable. Fannelop et al 13 stated that after 60 minutes of AXC, repeated oxygenated cold blood cardioplegia provides better myocardial protection and preservation of left ventricular function than a single dose of the HTK during early hours after de-clamping experimentally.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Bretschneider HTK and Blood Cardioplegia (4:1): A Prospective Randomized Study

Dericioğlu

Mıdı

et al. 2023

Thorac Cardiovasc Surg

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Background We compared the effect of intermittent blood and histidine-tryptophan-ketoglutarate (HTK) solution of Bretschneider on myocardial histopathology and perioperative outcome. Methods Forty adult cardiac surgery patients were grouped into two (n = 20 for each): (1) Intermittent blood cardioplegia (IBC): had repeated cold 4:1 blood cardioplegia and (2) HTK: had a single dose of cold HTK for cardioprotection. Creatine kinase (CK)-MB, Troponin-I (cTn-I), pH, and lactate were studied in coronary sinus blood before and after aortic cross-clamping (AXC) and systemic blood at postoperative 6th, 24th, and 48th hours. Myocardial biopsy was performed before and after AXC for light microscopy. Vacuolation, inflammation, edema, and glycogen were graded semiquantitatively (from 0 to 3). The myocardial apoptotic index was evaluated via the terminal deoxynucleotidyl transferase dUTP nick end labeling. Results There were no differences in perioperative clinical outcomes between the groups. The coronary sinus samples after AXC were more acidotic (7.15 ± 0.14 vs. 7.32 ± 0.07, p = 0.001) and revealed higher CK-MB (21.0 ± 12.81 vs. 12.60 ± 11.80, p = 0.008) in HTK compared with IBC. The HTK had significantly a higher amount of erythrocyte suspension intraoperatively compared with IBC (0.21 ± 0.53 vs. 1.68 ± 0.93 U, p = 0.001). Microscopically, myocardial edema was more pronounced in HTK compared with IBC after AXC (2.25 ± 0.91 vs. 1.50 ± 0.04, p = 0.013). While a significant increase in the apoptotic index was seen after AXC in both groups (p = 0.001), no difference was detected between the groups (p = 0.417). Conclusion IBC and HTK have a similar clinical outcome and protective effect, except for more pronounced myocardial edema and increased need for intraoperative transfusion with HTK.

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Section: Discussionmentioning

confidence: 99%

“…Moreover, advances in minimally invasive cardiac surgery make crystalloid solutions more popular as they offer to allow prolonged uninterrupted surgery. 12…”

Section: Discussionmentioning

confidence: 99%