Myocardial Protection in Minimally Invasive Mitral Valve Surgery: Comparison of the Cold-Blood Cardioplegia of the Bretschneider Solution and the Warm-Blood Cardioplegia of the Calafiore Protocol

Kammerer, Inna; Nagib, Ragi; Hipp, Gernot; Preßmar, M.; Hansen, Martin; Franke, Ulrich

doi:10.5455/aces.20120220022958

Cited by 12 publications

(13 citation statements)

References 17 publications

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“…We originally hypothesized that statistically significant differences in our clinical endpoints may be found by stratifying our data according to aortic cross‐clamp duration, that is, ischemic time of >90 min versus ischemic time of <90 min. However, screening of participating literature revealed, at present, only one RCT 18 ( n = 107) with mean cross‐clamp duration of >90 min, which alone would render statistically meaningless data. Surgical data analysis relies on regular publication from individual centers; greater clarity will be derived on our cross‐clamp duration hypothesis following the publication of further RCT data.…”

Section: Discussionmentioning

confidence: 91%

“…The seven studies 9,12‐18 included in the analysis had an aggregate of 804 participants, 412 of whom were HTK patients versus 391 who received MDC. The characteristics of the included studies are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…A further six studies were excluded as they were investigating pediatric cases; one study was excluded as it had a mixed population; and, three studies were excluded because they did not use HTK (Figure S1). Seven studies were included in our analysis 12‐18 …”

Section: Methodsmentioning

confidence: 99%

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HTK versus multidose cardioplegias for myocardial protection in adult cardiac surgery: A meta‐analysis

Reynolds

Asopa

Modi³

et al. 2021

J Card Surg

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Background Histidine–tryptophan–ketoglutarate (HTK) cardioplegia for myocardial protection obviates the need for maintenance cardioplegia doses, and thus allows for greater focus on procedure accuracy. The aim of this meta‐analysis is to evaluate the safety and efficacy of HTK versus multidose cardioplegias during cardiac surgery in an adult population. Methods Electronic searches were performed using PubMed, Science Direct, and Google Scholar databases. The key search terms included HTK cardioplegia AND cardiac surgery AND adult. This was followed by a meta‐analysis investigating cardiopulmonary bypass (CPB) duration, cross‐clamp duration, spontaneous defibrillation, inotropic support, mortality, atrial fibrillation, creatine kinase muscle brain band (CK‐MB) and troponin I (TnI). Results Seven randomized controlled trials (n = 804) were analyzed. Spontaneous defibrillation following aortic cross‐clamp removal significantly favored HTK (odds ratio [OR], 2.809; 95% confidence interval [CI], 1.574 to 5.012; I2 = 0%; p < .01). There were no other notable significant differences between HTK and multidose cardioplegia in any of the parameters measured. In particular, the OR for mortality was 1.237 (95% CI, 0.385 to 3.978; I2 = 0%; p = .721) and the mean difference for CPB duration overall was 2.072 min (95% CI, −2.405 to 6.548; I2 = 74%; p = .364). Conclusion HTK is safe and effective during adult cardiac surgery when compared with multidose cardioplegias for myocardial protection during surgical correction of acquired pathology in the adult population. HTK may, therefore, be suitable for complex cases or those of extensive duration, without the prospect of increased postoperative morbidity or mortality.

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Section: Discussionmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

HTK versus multidose cardioplegias for myocardial protection in adult cardiac surgery: A meta‐analysis

Reynolds

Asopa

Modi³

et al. 2021

J Card Surg

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“…A total of 40 journal articles were reviewed, with only the most current comparative studies being used. 7–46 Del Nido was an exception to this rule as comparative literature surrounding this solution was scarce. Review of the literature showed that 4:1 blood cardioplegia and Custodiol HTK cardioplegia were the most favored in randomized clinical trials, accounting for approximately 80% of trials.…”

Section: Resultsmentioning

confidence: 99%

Evidence-based medicine and myocardial protection — where is the evidence?

et al. 2014

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Uniform variables among different studies would be preferable for analysis of this topic; thus, it is the researchers' recommendation that the collection of multicenter data be undertaken in order to more fully answer this research question.Comparative effectiveness studies to associate commonly used solutions are needed. Without this research, surgeon preference remains the primary determining factor for deciding which cardioplegic solution to use. Cardioplegia selection should rely more on higher scientific research, using evidenced-based medicine and ranking of clinical studies.

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“…[14][15][16][17][18] It is easy to use, given as one single dose, and may enable sufficient myocardial protection for more than 2 hours of cardiac arrest. [19][20][21][22][23] Another example is the Del Nido solution. This blood and crystalloid mixed formula has been associated with a longer duration of safe myocardial ischemic arrest.…”

mentioning

confidence: 99%

Myocardial preservation methods in isolated minimal invasive mitral valve surgery: Society of Thoracic Surgeons (STS) database outcomes

et al. 2019

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Objective: Minimal invasive mitral valve surgery (MIMVS) has become a commonly used approach for mitral valve surgery. Several techniques of myocardial preservation were described in patients undergoing MIMVS. We aim to evaluate preservation technique and short term outcomes.Methods: A retrospective analysis of patients who underwent isolated MIMVS and were included in the Society of Thoracic Surgeons (STS) database. Results:The final cohort included 4976 patients. Mean age was 63.1 years (SD, 12.5) and 42.6% were females. Antegrade delivery method (71.3% of the patients) was the most common, follow by antergrade/retrograde (19.9%). Blood, crystalloid solution, and combination of blood-crystalloid were used in 62.4%, 13.2%, and 13.7%, respectively. In multivariate analysis, cardioplegia technique was associated with mortality (P = .011), pleural effusion (P = .045), and length of ICU stay (P < .001).Antegrade-crystalloid (OR, 3.37; 95%CI, 1.70-6.68) and antegrade/retrograde-blood/ crystalloid (OR, 3.28; 95%CI, 1.15-9.38) were associated with increased risk for mortality compared with antegrade-blood cardioplegia. Data on postoperative ejection fraction (EF), CPK-MB, and Troponin was available only in 30%, 9%, and 5% of the patients, respectively, and were not included in the analysis.Conclusions: Ante-grade-blood was the most common preservation technique in MIMVS. Ante-grade-crystalloid and ante-grade/retrograde-blood/crystalloid are associated with increased risk for mortality. The results suggest that using crystalloid solutions for cardioplegia should be carefully considered. The STS database as a source for MIMVS outcome analysis is lacking, both in detailed specification of different surgical technique aspects, and in actual data collection of already existing categories.

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Myocardial Protection in Minimally Invasive Mitral Valve Surgery: Comparison of the Cold-Blood Cardioplegia of the Bretschneider Solution and the Warm-Blood Cardioplegia of the Calafiore Protocol

Cited by 12 publications

References 17 publications

HTK versus multidose cardioplegias for myocardial protection in adult cardiac surgery: A meta‐analysis

HTK versus multidose cardioplegias for myocardial protection in adult cardiac surgery: A meta‐analysis

Evidence-based medicine and myocardial protection — where is the evidence?

Myocardial preservation methods in isolated minimal invasive mitral valve surgery: Society of Thoracic Surgeons (STS) database outcomes

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