Low-Dose Histidine-Tryptophan-Ketoglutarate Solution for Myocardial Protection

Arslan, Alev; Sezgin, Atilla; Gültekin, Bahadır; Özkan, Süleyman; Akay, Tankut; Uğuz, Emrah; Taşdelen, Atılay; Aşlamacı, Sait

doi:10.1016/j.transproceed.2005.08.020

Cited by 25 publications

(15 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There was a lower incidence of arrhythmias, inotropic support, and length of stay in the ICU. A study conducted previously in our clinic compared the two solutions on coronary artery bypass graft (CABG) patients . Aortic clamp times being 33.9 min for the HTK group and 36.2 min for the conventional cardioplegia group, the cardiac enzyme levels in the coronary sinus blood were not significantly different.…”

Section: Discussionmentioning

confidence: 96%

“…This is the case with the Bretchneider's histidine‐tryptophan‐ketoglutarate (HTK) solution. These two strategies have been compared clinically and experimentally ; however, there is no consensus on which solution provides a better myocardial protection. The clinical studies comparing the two solutions are mostly on adult patients.…”

mentioning

confidence: 99%

“…compared clinically and experimentally (2)(3)(4)(5); however, there is no consensus on which solution provides a better myocardial protection. The clinical studies comparing the two solutions are mostly on adult patients.…”

mentioning

confidence: 99%

See 2 more Smart Citations

The Comparison of the Effects of Bretschneider's Histidine‐Tryptophan‐Ketoglutarate and Conventional Crystalloid Cardioplegia on Pediatric Myocardium at Tissue Level

et al. 2013

View full text Add to dashboard Cite

Cardioplegic arrest is one of the most common myocardial protection strategies. A wide variety of cardioplegic solutions are routinely being used. There is an ongoing discussion about the relative effectiveness of these solutions considering myocardial protection. This study aims to investigate the hypothesis that the use of histidine-tryptophan-ketoglutarate (HTK) cardioplegia leads to decreased ischemic damage on myocardium compared with the use of conventional crystalloid cardioplegia. The study population was 32 patients operated on at Başkent University, Department of Cardiovascular Surgery for congenital heart diseases. The first group of 16 patients received conventional crystalloid cardioplegia (KK group) which is a modification of St. Thomas' solution, while the second group of 16 patients received HTK solution (HTK group). The echocardiographic measurements and the laboratory values of the patients were taken as the clinical variables. Right ventricular biopsies were taken from every patient before and after cardioplegic arrest. These biopsies were histopathologically examined for apoptosis using caspase-3 antigen and cell proliferation using Ki-67 antigen. The statistical analysis revealed no significant difference between the two groups regarding the clinical variables, apoptotic indices and proliferation indices. The apoptotic indices in the postcardioplegic arrest biopsies positively correlated with aortic clamp time in the KK group but not in the HTK group. Liver function tests on postoperative day 1 positively correlated with aortic clamp time in both groups. On postoperative day 2, this correlation was sustained in the KK group and ceased in HTK group. The difference in the correlation of apoptotic indices and liver function tests between the groups is accepted as a supportive finding for HTK solution. However, it can be postulated that when the aortic clamp times are similar to those in the present study, the clinical manifestation of the difference between the two solutions would not be significant.

show abstract

Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

See 1 more Smart Citation

The Comparison of the Effects of Bretschneider's Histidine‐Tryptophan‐Ketoglutarate and Conventional Crystalloid Cardioplegia on Pediatric Myocardium at Tissue Level

et al. 2013

View full text Add to dashboard Cite

show abstract

“…These studies discovered no significant difference between the two groups in terms of mortality, however, their findings on myocardial protection in terms of other specific indicators (listed in Table 4) varied in a fashion which seems to suggest that benefits of HTK cardioplegia become more pronounced with longer ACC. In the study by Arslan et al 12 , which involved shorter clamping time (less than 40 min) the only significant difference found was longer time to cardiac arrest in the HTK group, 63 vs. 54 seconds in the St. Thomas group, that could be a disadvantage because it causes more ischemic-reperfusion damage 10,12 . On the other hand, time to cardiac arrest in our study was of about 60 seconds for both groups, whereas ACC time was about 40-50 min.…”

Section: Summarized Factors Of Perioperative Myocardial Injurymentioning

confidence: 92%

Comparison of Custodiol® and modified St. Thomas cardioplegia for myocardial protection in coronary artery bypass grafting

et al. 2020

View full text Add to dashboard Cite

Background/Aim. Custodiol is a hyperpolarizing cardioplegic solution which has been used in our national cardiac surgical practice exclusively for the heart transplant surgery. Owing to its numerous advantages over the standard depolarizing solutions, Custodiol became cardioplegia of choice for all other cardiac surgical procedures in many cardiosurgical centers. This study evaluates myocardial protection of Custodiol compared to modified St. Thomas cardioplegia in coronary artery bypass surgery. Methods. In a prospective four-month study 110 consecutive adult patients who underwent primary isolated elective on-pump coronary artery bypass grafting (CABG) were randomized into Custodiol group (n=54) and modified St.Thomas group (n=50), based on the type of administered cardioplegia; six patients were excluded. Cardiac protection was achieved as antegrade cold crystalloid cardioplegia by one of the solutions. Myocardial preservation was assessed through following outcomes: spontaneous rhythm restoration post crossclamp, and postpoperative cardiac specific enzymes level, ejection fraction (EF) change, inotropic support, myocardial infarction (MI), atrial fibrillation (AF), and death. Results. Preoperative and intraoperative characteristics were similar except for a considerably longer cross-clamp time in the Custodiol group (49.1±19.0 vs. 41.0±12.9 minutes; p=0.022). Custodiol group exhibited a higher rate of return to spontaneous rhythm (31.5% vs. 20.0%; p=0.267), lower rates of AF (20.4% vs. 28%; p=0.496), MI (1.8% vs. 10.0%; p=0.075) and inotropic support (9.0% vs. 12.0%; p=0.651), albeit not statistically significant. There was an insignificant difference in peak value of Troponin I (5.0±3.92µg/L vs. 4.5±3.39µg/L; p=0.755) and Creatine Kinase-MB (26.9±15,4µg/L vs. 28.5±24.2µg/L; p=0,646) 6 hours post-surgery. EF reduction was comparable (0,81% vs. 1.26%; p=0.891). There were no deaths. Conclusions. Custodiol and modified St.Thomas cardioplegia have comparable cardioprotective effects in CABG surgery. The trends of less frequent MI, AF and inotropic support, despite the longer cross-clamp time in the Custodiol group may suggest that its benefits could be ascertained in a larger study. ApstraktUvod/Cilj. Custodiol je hiperpolari iraju i kardiolegi ni rastvor koji je kori en, u na oj nacionalnoj kardiohirur koj praksi, isklju ivo u transplantacionoj hirurgiji. Zbog svojih brojnih prednosti u odnosu na standarde, depolari iraju e rastvore, Custodiol je, u mnogim kardiohirur kim centrima, postao kardioplegija i bora a sve kardiohirur ke procedure. Cilj studije je procena miokardne protekcije rastvorom Custodiol-a u poređenju sa modifikovanom St. Thomas kardioplegijom u koronarnoj hirurgiji. Metode. Tokom prospektivne etveromese ne studijie, 110 u astopnih odraslih pacijenata podvrgnutih primarnoj, izolovanoj, elektivnoj operaciji aortokoronarnog bajpas su randomizirani na osnovu primenjene kardioplegije u Custodiol grupu (n=54) i modifikovanu St.Thomas

show abstract

“…The best method for preserving cardiac muscle viability during cardiac surgery without harm to myocardial function deserves extensive work and research (Mehlhorn U, 1995). The Bretschneider HTK solution is used widely for multiorgan preservation for transplantation, as well as a cardioplegic agent that allows single dose administration (Arslan A, 2005). It was proved that Custodiol HTK solution is simple to use, safe and practical and administered as one single dose.…”

Section: Introductionmentioning

confidence: 99%

Clinical Impact of Custodiol Cardioplegic Solution on Patients Undergoing Complex Cardiac Surgery With Mild to Moderate Impairment of Left Ventricular Systolic Function

Ramadan¹,

Abdelgawad

2017

ESJ

View full text Add to dashboard Cite

Background: The Bretschneider HTK solution is used widely for multiorgan preservation for transplantation, as well as a cardioplegic agent that allows single dose administration which is an attractive option for lengthy complex cardiac surgery. It was proved that it is simple to use, safe and practical. Moreover, it is considered to confer sufficient myocardial protection for more than 2 h of cardiac arrest. We undertook this descriptive study to analyze the performance of HTK solution in patients undergoing complex cardiac surgery with mild to moderate impairment of left ventricular systolic function. Patients and methods: A total of 50 patients underwent different complex cardiac surgery at national heart institute from January 2015 to November 2016 using single dose Custodiol cardioplegia as the primary and sole cardioplegic agent, their data was prospectively collected and their hospital outcome was analyzed as regards to ten study endpoints namely Prolonged ventilation, return to theatre for bleeding, renal failure, stroke, 30 days mortality, postoperative MI, need for inotropes, time on inotropes, ICU stay and hospital stay. Pre- and postoperative echocardiography was done to compare and evaluate the change of LV function using the parameters of End Systolic Dimension, End Diastolic Dimension, Fraction Shortening and Ejection Fraction of the left ventricle. Results: Half of the patients were males. Their age ranged between 16 – 65 years with a mean (standard deviation) of 47.46(11.10). preoperative ejection fraction ranged from 30 % to 49% with a mean (standard deviation) of 41.8 (6.32), the majority of them (64%) had NYHA class of 3 and half of them had CCS of 3. all patients were done electively. The most common procedure done was redo DVR 24% (12 patients) followed by Bentall operation 22%(11 patients). This is followed by CABG + MVR 7 patients (14%), then an equal number of 6 patients (12%) who underwent redo MVR post-infective endocarditis and CABG+ MVrep. The repair of tricuspid valve was done for 14 patients (28%) either with MVR or DVR. 4 patients (8%) had CABG +AVR for their combined lesions and another equal number of two patients (4%) underwent redo CABG and AVR + conduit (valve separate tube graft operation). prolonged ventilation occurred in 20% of the cases. An equal percentage of 6% of the patients had to return to the operative room and had postoperative MI. Renal failure occurred in 4% of the patients and as far as 30-day mortality is concerned, a similar 4% of patients died within this period. EF and FS were very similar when compared together (41.8 ± 6.32 %, 20.8 ± 2.35 % preoperatively compared to 41.92 ± 7.49%, 20.85 ± 3.25% postoperatively). P value was insignificant (0.937 and 0.929) respectively. Conclusion: A single dose of an HTK cardioplegic solution provides good myocardial protection in complex cardiac surgery with mild to moderate impairment of LV function and has a good immediate postoperative outcome.

show abstract

Low-Dose Histidine-Tryptophan-Ketoglutarate Solution for Myocardial Protection

Cited by 25 publications

References 7 publications

The Comparison of the Effects of Bretschneider's Histidine‐Tryptophan‐Ketoglutarate and Conventional Crystalloid Cardioplegia on Pediatric Myocardium at Tissue Level

The Comparison of the Effects of Bretschneider's Histidine‐Tryptophan‐Ketoglutarate and Conventional Crystalloid Cardioplegia on Pediatric Myocardium at Tissue Level

Comparison of Custodiol® and modified St. Thomas cardioplegia for myocardial protection in coronary artery bypass grafting

Clinical Impact of Custodiol Cardioplegic Solution on Patients Undergoing Complex Cardiac Surgery With Mild to Moderate Impairment of Left Ventricular Systolic Function

Contact Info

Product

Resources

About