Key result
Bretschneider-HTK cardioplegia resulted in a significantly higher rate of spontaneous sinus rhythm after aorta clamp release compared to St. Thomas cardioplegia (39.5% vs. 20.4%, p<0.005).
Why the study?
The hemodynamic effects of Bretschneider-HTK versus St. Thomas cardioplegic solutions after CABG and their relation to aortic occlusion time were not well characterized.
Does Bretschneider cardioplegic HTK solution improve hemodynamic performance after bypass compared to St. Thomas cardioplegic solution in CABG patients?
RCT (n=249)
randomized
Does Bretschneider cardioplegic HTK solution improve hemodynamic performance after bypass compared to St. Thomas cardioplegic solution in CABG patients?
Bretschneider HTK cardioplegia is associated with a higher rate of spontaneous sinus rhythm recovery after aortic unclamping compared to St. Thomas solution, though it may increase the temporary need for pacing.
Answers are grounded in this paper and cite their sources.
No definitive superiority between HTK and St. Thomas cardioplegia; leaves open optimal solution selection pending confirmatory trials.
A prospective consecutive study was undertaken to compare the hemodynamic effect of two cardioplegic solutions in CABG patients after bypass, and in relation to aorta occlusion time with the support of a automatic datalogging database. A total of 249 patients were randomized. One group received Bretschneider cardioplegic HTK solution (132 patients, group I) the other group received St. Thomas cardioplegic solution (117 patients, group II). The data was divided in four periods of aortic clamp time: less than or equal to 40 min (group I 26 patients, group II 32 patients); 41-60 min (group I 49 patients, group II 47 patients); 61-80 min (group I 30 patients, group II 29 patients); and greater than 80 minutes (group I 27 pts, group II 9 patients). Anesthesia regime and therapeutic drugs and infusions were given in both groups in similar dosages. Within both groups HR, CO, PAP, PCWP increased after bypass in relation to prebypass values. SVR decreased in both groups by 30%, MAP and PVR decreased only in group I. Between group I and II differences were found in the CI (3.0 vs. 3.3 l/min/m2), MAP (70 vs. 76 mmHg), PMAR (18 vs. 16 mHg), and SVR (827 vs. 954 dyn.sec.cm-5). In significantly more of the patients in group I, sinus rhythm started spontaneously after the release of the aorta clamp (39.5% vs. 20.4%, p less than 0.005). Patients in group I needed temporarily a pacemaker after bypass in 6.3% cases (in 1.1% of patients in group II,). There was no relation of the hemodynamic data in relation to aorta occlusion time within the groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Huet et al. (1988) conducted an RCT in Coronary Artery Bypass Grafting (CABG) (n=249). Bretschneider cardioplegic HTK solution vs. St. Thomas cardioplegic solution was evaluated on Spontaneous sinus rhythm after release of the aorta clamp (p=<0.005). Bretschneider-HTK cardioplegia resulted in a significantly higher rate of spontaneous sinus rhythm after aorta clamp release compared to St. Thomas cardioplegia (39.5% vs. 20.4%, p<0.005).
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