Clinical Effect of Bretschneider-HTK and St. Thomas Cardioplegia on Hemodynamic Performance after Bypass Measured using an Automatic Datalogging Database System

Huet, Rcgg; Karliczek, G.; Vanderheide, Jnh; Brenken, U; Mooi, B; Vanderbroeke, Jjw; Jenkins, [No Value]; Degeus, Af

doi:10.1055/s-2007-1020064

Cited by 22 publications

(11 citation statements)

References 2 publications

(2 reference statements)

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“…On the other hand, St. Thomas 2 cardioplegia is an extracellular cardioplegic solution, which is based on potassium and magnesium. Few studies compare the effect of either Bretschneider (Custodiol®) or St. Thomas 2 with other established cardioplegic solutions, but they have never been compared directly [10–13].…”

Section: Discussionmentioning

confidence: 99%

Bretschneider (Custodiol®) and St. Thomas 2 Cardioplegia Solution in Mitral Valve Repair via Anterolateral Right Thoracotomy: A Propensity-Modelled Comparison

Mork

Koechlin

Schaeffer

et al. 2019

Mediators of Inflammation

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Background Single-dose cardioplegia is preferred in minimal invasive mitral valve surgery to maintain the adjustment of the operative site without change of preset visualization. The aim of our study was to compare two widely used crystalloid cardioplegias Bretschneider (Custodiol®) versus St. Thomas 2 in patients who underwent mitral valve repair via small anterolateral right thoracotomy. Material and Methods From May 2012 until February 2019, 184 isolated mitral valve procedures for mitral valve repair via anterolateral right thoracotomy were performed using Bretschneider (Custodiol®) cardioplegia (n = 123) or St. Thomas (n = 61). Primary efficacy endpoint was peak postoperative high-sensitivity cardiac troponin (hs-cTnT) during hospitalization. Secondary endpoints were peak creatine kinase-muscle brain type (CK-MB) and creatine kinase (CK) as well as safety outcomes. We used inverse probability of treatment weighting (IPTW) in order to adjust for confounding by indication. Results Peak hs-cTnT was higher after use of Bretschneider (Custodiol®) (geometric mean 716 mg/L, 95% confidence interval (CI) 605-847 mg/L) vs. St. Thomas 2 (561 mg/L, CI 467-674 mg/L, p = 0.047). Peak CK-MB (geometric mean after Bretschneider (Custodiol®): 40 μg/L, CI 35-46, St. Thomas 2: 33 μg/L, CI 27-41, p = 0.295) and CK (geometric mean after Bretschneider (Custodiol®): 1370 U/L, CI 1222-1536, St. Thomas 2: 1152 U/L, CI 972-1366, p = 0.037) showed the same pattern. We did not see any difference with respect to postoperative complications between treatment groups after IPTW. Conclusion Use of St. Thomas 2 cardioplegia was associated with lower postoperative peak levels of all cardiac markers that reflect cardiac ischemia such as hs-cTnT, CK, and CK-MB as compared to Bretschneider (Custodiol®) in propensity-weighted treatment groups.

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Section: Discussionmentioning

confidence: 99%

Bretschneider (Custodiol®) and St. Thomas 2 Cardioplegia Solution in Mitral Valve Repair via Anterolateral Right Thoracotomy: A Propensity-Modelled Comparison

Mork

Koechlin

Schaeffer

et al. 2019

Mediators of Inflammation

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“…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%

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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“…2 Direct effects of cardioplegia solutions during surgery may also induce a hypercirculatory syndrome. 3 Surgical manipulation during these operations may potentiate these effects. However, even if the etiology of postoperative hypercirculatory syndrome is unknown, it is known that the insult that initiates the response is going to occur, and that it may adversely influence patient outcome due to postoperative organ dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Hemofiltration in Adults: Prevention of Hypercirculatory Syndrome?

Tirilomis

Friedrich

Sı̂rbu

et al. 2005

Asian Cardiovasc Thorac Ann

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Hypercirculatory syndrome (HCS) after cardiac surgery may be a sequela of extracorporeal circulation due to hemodilution and release of inflammatory mediators. The aim of this study was to investigate the influence of intraoperative hemofiltration (HF) on the incidence of HCS. A prospective cohort study of 80 patients scheduled for elective coronary bypass was performed. The patients were randomized to two groups: in the conventional (CONV) group 40 patients were treated conventionally and in the HF group 40 patients underwent intraoperative HF. There was no perioperative mortality. The incidence of HCS was comparable in both groups (32% in CONV group versus 40% in HF group; n.s.). Mean cardiac output was higher and systemic vascular resistance lower in CONV group patients than in HF group patients, however these differences did not reach statistical significance. According to this data intraoperative HF does not prevent postoperative HCS induced by cardiopulmonary bypass. Further studies are required to identify the etiology of HCS, and to prevent it occurring after open-heart surgery.

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Clinical Effect of Bretschneider-HTK and St. Thomas Cardioplegia on Hemodynamic Performance after Bypass Measured using an Automatic Datalogging Database System

Cited by 22 publications

References 2 publications

Bretschneider (Custodiol®) and St. Thomas 2 Cardioplegia Solution in Mitral Valve Repair via Anterolateral Right Thoracotomy: A Propensity-Modelled Comparison

Bretschneider (Custodiol®) and St. Thomas 2 Cardioplegia Solution in Mitral Valve Repair via Anterolateral Right Thoracotomy: A Propensity-Modelled Comparison

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

Intraoperative Hemofiltration in Adults: Prevention of Hypercirculatory Syndrome?

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