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

Abstract

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.

Assessment of the Need for Cardiac Support Using Custodiol HTK Cardioplegia versus Traditional Crystalloid Cardioplegia

“…Patients who only needed one distal anastomosis, those with malfunction of the left ventricle, along with an ejection fraction of less than 45%, those who had recently suffered a myocardial infarction (8 to 30 days prior to surgery), or those with concurrent cardiac valve disease or unstable angina and were among the first group of patients and patients undergoing cardioversion before surgery, renal insufficiency (creatinine >3 mg/L), or cerebrovascular illness (internal carotid artery stenosis >80%). Based on the calculation, the sample size was equivalent to 24 cases for each group (11)(12)(13) .…”

Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia

“…The Bretschneider cardioplegia—preventing the exhaustion of energy constituents and preserving ultrastructural integrity—is suitable for cold static preservation of the heart at a temperature of 2–4 °C when transporting it to the recipient’s site, approved by the U.S. Food and Drug Administration [ 71 , 72 , 73 , 74 ]. Harnessing the pivotal role of the high buffering capabilities of HTK, tissue acidosis secondary to long-lasting ischemia decreases, as Kallerhof et al observed when studying rat hearts following cold storage in an HTK solution.…”