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June 10, 2011Perfusion

Myocardial protection during aortic surgery: comparison between Bretschneider-HTK and cold blood cardioplegia

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Key result

Bretschneider-HTK and cold blood cardioplegia provided similar overall myocardial protection, but HTK yielded lower cTnI peak values in patients with cross-clamp times >160 minutes (p=0.044).

Why the study?

Does Bretschneider-HTK cardioplegia improve myocardial protection compared to cold blood cardioplegia in patients undergoing thoracic aorta operations?

Population

112 patients undergoing elective or emergent thoracic aorta operations

Comparison

Bretschneider-HTK cold crystalloid single-dose… vs Cold blood multidose cardioplegia

Design

Cohort

Follow-up

In-hospital (post-operative)

Authors

GSGiuseppe ScrasciaOspedale Pediatrico Giovanni XXIIIPGPiero GuidaUniversity of PaduaCRCrescenzia RotunnoSanta Maria Nuova Hospital

Discussion

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Implication

May support HTK preference for aortic cases with cross-clamp >160 min; leaves open need for randomized confirmation of benefit.

Key Points

  • This research aims to compare the effectiveness of Bretschneider-HTK and cold blood cardioplegia in providing myocardial protection during thoracic aortic surgeries.
  • Evaluated 112 patients undergoing elective or emergent thoracic aorta surgery with HTK or cold blood cardioplegia solutions.
  • Measured postoperative cardiac Troponin I levels, incidence of low cardiac output syndrome, and mortality rates.
  • Conducted two-way ANOVA to analyze the effects of cardioplegic solution type across varying cross-clamp time quintiles.
  • cTnI peak release was significantly higher in the cold blood group during prolonged cross-clamp time (p=0.044).
  • No significant differences in inotropic support and arrhythmias between both groups.
  • Overall, both types of cardioplegia provided similar myocardial protection in patients undergoing surgery.

Study Design

Type

Cohort (n=112)

Structured PICO

Does Bretschneider-HTK cardioplegia improve myocardial protection compared to cold blood cardioplegia in patients undergoing thoracic aorta operations?

P
Population
112 patients undergoing elective or emergent thoracic aorta operations.
E
Exposure
Bretschneider-HTK (Custodiol) cold crystalloid single-dose intracellular cardioplegia
C
Comparator
Cold blood multidose cardioplegia
O
Outcome
Post-operative cardiac Troponin I (cTnI) release, low cardiac output syndrome (LCOS), and mortalitysurrogate

Bretschneider-HTK and cold blood cardioplegia provide similar overall myocardial protection during thoracic aorta surgery, but HTK may offer superior protection (lower cTnI release) during prolonged cross-clamp times (>160 min).

Cite This Study

Scrascia et al. (2011) conducted a cohort in Thoracic aorta operations (n=112). Bretschneider-HTK (Custodiol) cardioplegic solution vs. Cold blood multidose cardioplegia was evaluated on Post-operative cardiac Troponin I (cTnI) release, low cardiac output syndrome (LCOS), and mortality. Bretschneider-HTK and cold blood cardioplegia provided similar overall myocardial protection, but HTK yielded lower cTnI peak values in patients with cross-clamp times >160 minutes (p=0.044).

synapsesocial.com/papers/6a33834fef74b219d519b419https://doi.org/10.1177/0267659111409276
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