Multidose Cold Oxygenated Blood Is Superior to a Single Dose of Bretschneider HTK-Cardioplegia in the Pig

Fanneløp, Tord; Dahle, Geir; Salminen, Pirjo-Riitta; Moen, Christian Arvei; Matre, Knut; Mongstad, Arve; Eliassen, Finn; Segadal, Leidulf; Grong, Ketil

doi:10.1016/j.athoracsur.2009.01.041

Cited by 29 publications

(21 citation statements)

References 19 publications

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“…function (LVEF <30%, NYHA ≥III) or prior cardiac surgery probably for the widespread opinion that intermittently BCP provides higher myocardial preservation due to its more physiological properties and oxygen-carrying capacity (4,11). This seems to be in accordance also with Braathen et coll.…”

Section: Editorialsupporting

confidence: 78%

Comparison of the different cardioplegic strategies in cardiac valves surgery: who wins the “arm-wrestling”?

Castaldo¹,

Giordano²,

Palma³

2018

J. Thorac. Dis.

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Section: Editorialsupporting

confidence: 78%

Comparison of the different cardioplegic strategies in cardiac valves surgery: who wins the “arm-wrestling”?

Castaldo¹,

Giordano²,

Palma³

2018

J. Thorac. Dis.

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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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“…We did not find any differences in rise in serum troponin-T and CK-MB levels at 3 hours after unclamping between the B group and the H group. Fannelop et al 6 had found that serum troponin-T release was lower in the CBC group compared with the HTK group after 60 minute of aortic cross-clamping in a juvenile pig model. The result of our study can be interpreted by the younger age of animals and the longer cross-clamping time: Compared with adult hearts, neonatal hearts are more tolerant to a global ischemia due to metabolic differences, and they have better recovery of endothelial function and coronary blood flow after hypothermic ischemia/reperfusion.…”

Section: Discussionmentioning

confidence: 98%

“…[3][4][5] Experimental studies have shown, however, that HTK solution provides inadequate cardioprotection when compared to CBC. 6,7 The relative advantage of blood cardioplegia in relation to crystalloid cardioplegia is still the subject of debate in pediatric cardiac surgery. 8,9 Angeli et al 10 reported that HTK solution was applied to newborns undergoing arterial switch operations with a mean of 98 minutes of cardiac arrest; however, the authors did not use any control group.…”

mentioning

confidence: 99%

“…Moreover, the safety of HTK used for prolonged ischemic time (over 75 minutes) has not been documented. 3,6,7 Our previous study showed that HTK solution results in less spontaneous ventricular fibrillation and lower mortality when compared to St. Thomas solution, and HTK is valid for complex congenital cardiac surgery with a prolonged cross-clamping time (105-242 minute). 11 Therefore, we wanted to compare the effect of cold HTK with that of CBC, which was assumed to be the best cardioplegia method, on a neonatal piglet model.…”

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confidence: 99%

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Which Is the Better Option During Neonatal Cardiopulmonary Bypass

Chen

Liu

et al. 2013

ASAIO Journal

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The optimal myocardial protection strategy for newborns/infants undergoing congenital heart surgery remains controversial. The purpose of this study was to compare myocardial protection using histidine-tryptophan-ketoglutarate (HTK) and cold blood cardioplegia in a neonatal piglet model. Twenty-one piglets were randomized to three groups: the control group (C group, n = 7), a single dose of HTK group (H group, n = 7), and multidose cold blood cardioplegia group (B group, n = 7). Animals in the two experimental groups were placed on hypothermic cardiopulmonary bypass, after which the ascending aorta was clamped for 2 hours. Immediately after declamping, both the difference between arterial and coronary sinus blood lactate concentrations and the oxygen extraction did not differ between the H group and the B group. At 3 hours after declamping, rise in serum troponin-T and creatine kinase isoenzyme MB levels showed no significant differences between the H group and the B group (p = 0.735 and p = 0.103, respectively). No significant differences were noted in the myocardial lactate content, ATP content, and histopathological score between the H group and the B group (p = 0.810, p = 0.158, and p = 0.399, respectively). Transfusion requirement in the B group was significantly more than that in the H group (p = 0.003). HTK solution provides equivalent myocardial protection to multidose cold blood cardioplegia for the neonatal heart with less transfusion requirement.

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Multidose Cold Oxygenated Blood Is Superior to a Single Dose of Bretschneider HTK-Cardioplegia in the Pig

Cited by 29 publications

References 19 publications

Comparison of the different cardioplegic strategies in cardiac valves surgery: who wins the “arm-wrestling”?

Comparison of the different cardioplegic strategies in cardiac valves surgery: who wins the “arm-wrestling”?

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

Which Is the Better Option During Neonatal Cardiopulmonary Bypass

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