Scavenging right atrial Bretschneider histidine-tryptophan-ketoglutarate cardioplegia: Impact on hyponatremia and seizures in pediatric cardiac surgery patients

Turner, Immanuel; Ruzmetov, Mark; Niu, Jianli; Bibevski, Steven; Scholl, Frank G.

doi:10.1016/j.jtcvs.2020.08.098

Cited by 11 publications

(11 citation statements)

References 13 publications

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“…Up to 90% of ATP in myocardium is generated through the oxidation of fatty acids in adults, but through the oxidation of glucose in children ( 34 ). Tryptophan and ketoglutaric acid in HTK enhance myocardial glycolysis during ischemia and maintain high levels of intracellular ATP via two energy-generating pathways ( 35 ), which may explain its superior performance in pediatric cardiac surgery. At the same time, the lack of calcium in HTK may alleviate intracellular calcium overload during ischemia/reperfusion, to which pediatric myocardium is more sensitive than adult myocardium ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Comparative effects of different types of cardioplegia in cardiac surgery: A network meta-analysis

Tan

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveTo compare the outcomes of four types of cardioplegia during cardiac surgery: del Nido (DN), blood cardioplegia (BC), histidine-tryptophan-ketoglutarate (HTK) and St. Thomas.MethodsRandomized controlled trials (RCTs) and observational cohort studies from 2005 to 2021 were identified in PubMed, Embase, and Cochrane databases. Data were extracted for the primary endpoint of perioperative mortality as well as the following secondary endpoints: atrial fibrillation, renal failure, stroke, use of an intra-aortic balloon pump, re-exploration, intensive care unit stay and hospital stay. A network meta-analysis comparing all four types of cardioplegia was performed, as well as direct meta-analysis comparing pairs of cardioplegia types.ResultsData were extracted from 18 RCTs and 49 observational cohort studies involving 18,191 adult patients (55 studies) and 1,634 children (12 studies). Among adult patients, risk of mortality was significantly higher for HTK (1.89, 95% CI 1.10, 3.52) and BC (RR 1.73, 95% CI 1.22, 2.79) than for DN. Risk of atrial fibrillation was significantly higher for BC (RR 1.41, 95% CI 1.09, 1.86) and DN (RR 1.51, 95% CI 1.15, 2.03) than for HTK. Among pediatric patients, no significant differences in endpoints were observed among the four types of cardioplegia.ConclusionsThis network meta-analysis suggests that among adult patients undergoing cardiac surgery, DN may be associated with lower perioperative mortality than HTK or BC, while risk of atrial fibrillation may be lower with HTK than with BC or DN.

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Section: Discussionmentioning

confidence: 99%

Comparative effects of different types of cardioplegia in cardiac surgery: A network meta-analysis

Tan

et al. 2022

Front. Cardiovasc. Med.

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“…Concerns have been raised regarding the subsequent hyponatremia, on account of a large quantity of low Na + infusions [ 67 , 68 ]. With a concentration of 15 mmol/L of NaCl, HTK is, in effect, a hyponatremic compound and a rather hyperosmolar solution, given the fact that it has 310 mOsmol/L due to the abundance of amino acids.…”

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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“…Turner and colleagues present their experience with Custodial-HTK cardioplegia (Custodiol-HTK Koheler Chemie, GmbH, Bensheim, Germany) administration and the influence of its right atrial scavenging on hyponatremia and seizures. 1 They retrospectively analyzed all patients aged 18 years and younger who underwent cardiopulmonary bypass between January 2016 and March 2018 and found that 70% of patients in the nonscavenge group had serum sodium levels <130 mEq/L, whereas 21% of the patients in the scavenge group experienced the same. They further found that 87.5% of patients who had seizures had serum sodium levels <130 mEq/L, whereas no patient with a serum sodium level 130 mEq/L experienced a seizure.…”

mentioning

confidence: 99%

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

Abdullah

Al‐Halees

2021

The Journal of Thoracic and Cardiovascular Surgery

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in the immediate postoperative period, caused by inadequate monitoring and control of the homeostasis and inappropriate management of the cerebral perfusion and oxygen delivery. [8][9][10] With all the above factors influencing the myocardial function and the neurodevelopment, it seems simplistic to propose a solution, or the scavenging of cardioplegia, as the magic bullet taking care of both the myocardial and cerebral protection, without analyzing and evaluating all the elements contributing to the overall outcomes.

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Scavenging right atrial Bretschneider histidine-tryptophan-ketoglutarate cardioplegia: Impact on hyponatremia and seizures in pediatric cardiac surgery patients

Cited by 11 publications

References 13 publications

Comparative effects of different types of cardioplegia in cardiac surgery: A network meta-analysis

Comparative effects of different types of cardioplegia in cardiac surgery: A network meta-analysis

Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia

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

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