Comparison of the Solutions of Bretschneider, St. Thomas’ Hospital and the National Institutes of Health for Cardioplegic Protection during Moderate Hypothermic Arrest

Abstract

We evaluated three cardioplegic solutions, Bretschneider’s cardioplegic solution (HTK), St. Thomas’ Hospital solution (STH) and the solution of the National Institutes of Health (NIH), a solution with added nitroglycerin and lidocaine, for their ability to minimize ischemia-reperfusion injury in a working rat heart model. After cardioplegic arrest at 4°C and subsequent 45 min of ischemic storage at 25°C the function recovery of hearts was examined during 1 h of normothermic crystalloid reperfusion using Krebs-Henseleit buffer as perfusion medium. We noted a significantly better preservation of the maximum (+dp/dt_max) and minimum (–dp/dt_max) velocity of pressure development and a significantly higher coronary flow with the use of HTK (2,657 mm Hg/s, 2,122 mm Hg/s, 17 ml/min) compared to STH (1,600 mm Hg/s, p < 0.05; 1,591 mm Hg/s, p < 0.05; 11 ml/min, p < 0.05), and an intermediate level of preservation of hemodynamic parameters with NIH (2,149 mm Hg/s, 1,766 mm Hg/s, 12 ml/min). Concerning the cardiac output, however, no major difference was found between the HTK (41 ml/min), the STH (34 ml/min) and the NIH group (36 ml/min). The decay of the myocardial energy charge was significantly lower in both the HTK and the NIH group as compared with conservation in STH solution. Lactate was lowest in the HTK group, CK and LDH releases in the effusate remained lowest after HTK and NIH preservation. The data of this study suggest that HTK and NIH most perfectly reduce the impairment of myocardial function and provide better myocardial protection during ischemic arrest at 25°C and superior recovery compared to STH solution.

Impact of Organ Preservation Using HTK for Graft Flush and Subsequent Storage in UW in Rat Kidney Transplantation

“…As aforementioned, UW has a higher viscosity, may cause vasoconstriction due to its relatively high potassium concentrations [18] , and has a potential erythrocyte-aggregating effect [4] . In contrast, perfusion with HTK may allow for higher flows and also for more efficient cooling than UW, and has demonstrated superior properties to preserve ATP concentrations in the mild hypothermic range of 15-32 ° C, which is typically found in the initially cooling process during organ flushing [19,20] . In a protocol that applies kidney machine perfusion prior to transplantation, Daemen et al [21] have already demonstrated a possible benefit of combining HTK and UW for kidney preservation in non-heart-beating donors after warm ischemia.…”

Cardioprotective Effects of Low-Dose Cyclosporin A Added to Histidine-Tryptophan-Ketoglutarate Cardioplegia Solution prior to Total Myocardial Ischemia: An in vitro Rabbit Heart Study

“…Like other cold crystalloid cardioplegia solutions, it arrests and cools the heart, decreasing its metabolic requirements during ischemia. In addition to this, it contains histidine (H) which provides a strong buffer capacity, tryptophan (T) which has cell mem- brane-protective effects, and ␣ -ketoglutarate (K) which is thought to aid ATP production [22] . There has been considerable progress in understanding the role of the MPTP in IR injury and the effect of blocking the MPTP with CsA is well documented [5-14, 16, 17, 23-25] .…”

Postischemic cardiac function recovery in the isolated rat heart: effects of adenosine deaminase and nucleoside transport inhibition

“…After thoracotomy, the hearts were excised under topical cooling, immersed in cold Krebs-Henseleit buffer (KHB; 4°C) solution, and mounted on the aortic cannula. Then, according to the Langendorff technique, a nonrecirculating retrograde perfusion was initiated [13] (Fig. 1).…”

“…Measurement of hemodynamic parameters and collection of perfusate for the determination of enzyme and lactate releases were performed after 15 min of preischemic Langendorff perfusion and after the storage period as previously described in detail [13] ( Fig. 1).…”

“…We tested for a possible reduction of ischemiareperfusion injury by assessing postischemic recovery of cardiac function in rats. In our experimental model of an isolated perfused rat heart [13,14,15], the working parameters of the heart defined the variables used to compare the different treatment groups.…”