Commentary: Custodiol-HTK: Should the burden be on the surgeon or the perfusionist?

Abdullah, Ibrahim; Al‐Halees, Zohair

doi:10.1016/j.jtcvs.2020.09.010

Cited by 2 publications

(3 citation statements)

References 4 publications

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“…Previous studies have shown that the use of HTK in pediatric cardiac surgeries can cause acute hyponatremia, which can lead to a higher risk of postoperative seizures [ 9 , 12 ]. Although the rapid correction of HTK-induced hyponatremia in pediatric patients has been considered harmful [ 16 ], right atrial effluent scavenging has been approved in this age group to prevent sodium level fluctuations and further development of postoperative seizures [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…The use of HTK solution during cardiopulmonary bypass (CPB) can induce hyponatremia, which may be associated with postoperative seizures in pediatric patients [ 9 , 12 ]. The occurrence of acute hyponatremia during HTK cardioplegia has been observed in adults; however, hyponatremia correction is not always recommended because of the potential risk of hypertonicity and subsequent adverse events [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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The Potential Neurological Impact of Intraoperative Hyponatremia Using Histidine–Tryptophan–Ketoglutarate Cardioplegia Infusion in Adult Cardiac Surgery

Hu,

Hsieh,

Liang

et al. 2024

Medicina

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Background and Objectives: The relationship between histidine–tryptophan–ketoglutarate (HTK)-induced hyponatremia and brain injury in adult cardiac surgery patients is unclear. This study analyzed postoperative neurological outcomes after intraoperative HTK cardioplegia infusion. Materials and Methods: A prospective cohort study was conducted on 60 adult patients who underwent cardiac surgery with cardiopulmonary bypass. Of these patients, 13 and 47 received HTK infusion and conventional hyperkalemic cardioplegia, respectively. The patients’ baseline characteristics, intraoperative data, brain injury markers, Mini-Mental State Examination (MMSE) scores, and quantitative electroencephalography (qEEG) data were collected. Electrolyte changes during cardiopulmonary bypass, the degree of hyponatremia, and any associated brain insults were evaluated. Results: The HTK group presented with acute hyponatremia during cardiopulmonary bypass, which was intraoperatively corrected through ultrafiltration and normal saline administration. Postoperative sodium levels were higher in the HTK group than in the conventional cardioplegia group. The change in neuron-specific enolase levels after cardiopulmonary bypass was significantly higher in the HTK group (p = 0.043). The changes showed no significant differences using case–control matching. qEEG analysis revealed a significant increase in relative delta power in the HTK group on postoperative day (POD) 7 (p = 0.018); however, no significant changes were noted on POD 60. The MMSE scores were not significantly different between the two groups on POD 7 and POD 60. Conclusions: HTK-induced acute hyponatremia and rapid correction with normal saline during adult cardiac surgeries were associated with a potential short-term but not long-term neurological impact. Further studies are required to determine the necessity of correction for HTK-induced hyponatremia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Potential Neurological Impact of Intraoperative Hyponatremia Using Histidine–Tryptophan–Ketoglutarate Cardioplegia Infusion in Adult Cardiac Surgery

Hu,

Hsieh,

Liang

et al. 2024

Medicina

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show abstract

“…The mean decrease in plasma Na + was 15 mmol/L as compared to the preoperative state, with a constant osmolality. Slight isotonic hyponatremia is considered a harmless condition and it should therefore not be treated aggressively, or not at all, since (managed excessively) it can lead to acute hypernatremia with deleterious repercussions [ 69 , 70 ].…”

Section: Bretschneidermentioning

confidence: 99%

Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia

Ghiragosian

Harpa

Stoica

et al. 2022

JCDD

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The race for an ideal cardioplegic solution has remained enthusiastic since the beginning of the modern cardiac surgery era. The Bretschneider solution, belonging to the “intracellular cardioplegic” group, is safe and practical in myocardial protection during ischemic time. Over time, some particular concerns have arisen regarding the effects on cardiac metabolism and postoperative myocardial functioning. This paper reviews the most important standpoints in terms of theoretical and practical analyses.

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Commentary: Custodiol-HTK: Should the burden be on the surgeon or the perfusionist?

Cited by 2 publications

References 4 publications

The Potential Neurological Impact of Intraoperative Hyponatremia Using Histidine–Tryptophan–Ketoglutarate Cardioplegia Infusion in Adult Cardiac Surgery

The Potential Neurological Impact of Intraoperative Hyponatremia Using Histidine–Tryptophan–Ketoglutarate Cardioplegia Infusion in Adult Cardiac Surgery

Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia

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