Myocardial protection for transplantation

Garlicki, M; Kołcz, Jacek; Rudziński, Paweł; Kapelak, Bogusław; Sadowski, Jerzy; Wójcik, Sławomir; Pietrzyk, Edward; Frasik, W; Drukała, Justyna; A, Dziatkowiak

doi:10.1016/s0041-1345(99)00269-9

Cited by 21 publications

(7 citation statements)

References 5 publications

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“…Celsior was initially the preservation solution of theoretical choice based on promising results of animal studies and early clinical studies. [23][24][25][26][27][28][29][30][31][32][33] However, newer studies, including a recent metaanalysis, have suggested that UW may confer a survival advantage to recipients. [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] This benefit is thought to be partially due to the high potassium concentration, which leads to faster cardiac arrest and therefore less energy expenditure; however, this is likely dampened by the detrimental effect of high potassium concentration on coronary vascular endothelium.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Cardiac Preservation Solutions on Heart Transplant Survival

Carter

Lirette

Baran

et al. 2019

Journal of Surgical Research

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Background: Limited data exist that compare the predominant cardiac preservation solutions (CPSs). Materials and methods: The United Network for Organ Sharing database was retrospectively reviewed from January 1, 2004 to March 31, 2018, for donor hearts. Of 34,614 potential donors, 21,908 remained after applying the exclusion criteria. The CPS analyzed included saline, the University of Wisconsin (UW), cardioplegia, Celsior, and Custodiol. The primary endpoints were recipient survival and posttransplant rejection. Logistic and Cox models were used to quantify survival endpoints. Results: Saline was used as the CPS in 2549 patients (12%), UW in 10,549 (48%), cardioplegia in 1307 (6%), Celsior in 5081 (23%), and Custodiol in 2422 (11%). Donor age ranged from 15 to 68 y (mean ¼ 32.0 y, median ¼ 30.0 y), and 71% were male. Adjusted survival probabilities of recipients whose donor hearts were procured with saline was 96% 30 d, 90% 1 y, UW: 97% 30 d, 92% 1 y, cardioplegia: 95% 30 d, 87% 1 y, Celsior: 96% 30 d, 90% 1 y, and Custodiol: 97% 30 d, 92% 1 y. When these comparisons were adjusted for donor age, sex, ethnicity, ischemic time, recipient age, sex, ethnicity, creatinine, ventricular assist device (VAD), length of stay, region and days on waiting list, cardioplegia solution was demonstrated to have a higher risk of death (30 d, 1 y, overall) and posttransplant rejection versus UW (odds ratio 1.70, P ¼ 0.001; odds ratio 1.63, P < 0.001; hazard ratio 1.22, P < 0.001; hazard ratio 1.21, P < 0.001, respectively). Conclusions: Cardioplegia solutions for cardiac preservation are associated with a higher mortality in heart transplant recipients.

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Section: Discussionmentioning

confidence: 99%

The Effect of Cardiac Preservation Solutions on Heart Transplant Survival

Carter

Lirette

Baran

et al. 2019

Journal of Surgical Research

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“…Twenty-five of the 38 studies report positive results with regard to GIK infusions [12,[16][17][18]21,26,[32][33][34][37][38][39]46,49,51,[53][54][55][56][57]59,[63][64][65][66][67], 11 studies report neutral or negative results [13,22,27,35,52,58,60,61,[68][69][70], and two studies [50,62] argue neither for nor against GIK infusions, as both studies were primarily not aimed at GIK effects but on other endpoints.…”

Section: Discussionmentioning

confidence: 99%

“…These parameters were very different between the individual studies and between the GIK group and control group, even within one single study. In six of the studies, no information was provided at all on the duration of either CBP or ACC [32,33,53,[60][61][62]. In other studies, CPB lasted from 70 AE 20 min [58] to 159 AE 4 min [49] in the control group, 27 min [54] in the GIK group, and ACC lasted 128 AE 42 min in the control group [50].…”

Section: Surgical Proceduresmentioning

confidence: 99%

Forty years of glucose–insulin–potassium (GIK) in cardiac surgery: a review of randomized, controlled trials

Schipke

Friebe

Gams

2006

European Journal of Cardio-Thoracic Surgery

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Glucose-insulin-potassium (GIK) solutions have been used in cardiac surgery for more than 40 years. At that time, membrane-polarizing and stabilizing effects on cardiomyocyte's action potential were regarded the main benefit. Two meta-analyses described methodological flaws in the early studies (e.g., case numbers, randomization principles, and levels of significance), and came to clearly different recommendations with regard to the usage of GIK in the therapy of acute myocardial function. During the 70s, as promising therapies for the treatment of AMI had become available (e.g., beta-blockers and thrombolytic agents), the GIK technique was more widely introduced in cardiac surgery, e.g., during valve replacement. At present, 74 of 91 studies provide convincing evidence for the beneficial effects of insulin and/or GIK in cardiac surgery that go far beyond simple metabolic benefits and also include better recovery of myocardial tissue after ischemia. Yet, the exact underlying mechanisms remain still unknown. In this review article, two questions will be answered: why did GIK not become daily routine in cardiac surgery in spite of positive results from clinical studies, and does this technique merit more acceptance among the potential users? In view of the increasing number of older patients at higher risk, the demand for improving surgical procedures has renewed the interest in the GIK concept. The more recent literature suggests that the entire potential of GIK solutions has not been fully disclosed. A large single or multicenter trial with sound endpoints is mandatory.

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“…23 The longest ischemic time for donor hearts in recent years is 13 hr with HTK. 19 Garlicki et al 24 reported, in a trial with 224 patients, a trend toward decreased need for inotropic agents postoperatively in patients receiving hearts stored in HTK as compared with patients receiving hearts stored in CEL or University of Wisconsin solution. In contrast, the preliminary data of a randomized prospective study with 48 human heart transplantations indicated that recipients of hearts stored in HTK (7/24) needed more postoperative inotropic support than the recipients of hearts Values are means ± SD; n = 3, *P = .006 vs CEL, yP < .001 vs saline, zP < .001 vs saline.…”

Section: Discussionmentioning

confidence: 99%