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Thorac Cardiovasc Surg 2024; 72(01): 011-020
DOI: 10.1055/s-0042-1759710
Original Cardiovascular

Comparison of Bretschneider HTK and Blood Cardioplegia (4:1): A Prospective Randomized Study

Koray Ak   *
1   Department of Cardiovascular Surgery, Marmara University School of Medicine, Marmara Uninersitesi Hastanesi Mimar Sinan Cad. Fevzi Cakmak Mah. Ust Kaynarca Kalp ve Damar Cerrahisi Bolumu Pendik, Istanbul, Turkey
,
Okan Dericioğlu   *
2   Department of Cardiovascular Surgery, Marmara University School of Medicine, Istanbul, Turkey
,
Ahmet Midi
3   Department of Pathology, Bahcesehir University, School of Medicine, Istanbul, Turkey
,
Alper Kararmaz
4   Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey
,
Zafer Er
5   Department of Cardiovascular Surgery, Bozok University Faculty of Medicine Ringgold Standard Institution, Yozgat, Yozgat, Turkey
,
Zeynep Doğusan
6   Department of Pathology, Bone Marrow Transplantation Unite, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
,
Sinan Arsan
2   Department of Cardiovascular Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Abstract

Background We compared the effect of intermittent blood and histidine-tryptophan-ketoglutarate (HTK) solution of Bretschneider on myocardial histopathology and perioperative outcome.

Methods Forty adult cardiac surgery patients were grouped into two (n = 20 for each): (1) Intermittent blood cardioplegia (IBC): had repeated cold 4:1 blood cardioplegia and (2) HTK: had a single dose of cold HTK for cardioprotection. Creatine kinase (CK)-MB, Troponin-I (cTn-I), pH, and lactate were studied in coronary sinus blood before and after aortic cross-clamping (AXC) and systemic blood at postoperative 6th, 24th, and 48th hours. Myocardial biopsy was performed before and after AXC for light microscopy. Vacuolation, inflammation, edema, and glycogen were graded semiquantitatively (from 0 to 3). The myocardial apoptotic index was evaluated via the terminal deoxynucleotidyl transferase dUTP nick end labeling.

Results There were no differences in perioperative clinical outcomes between the groups. The coronary sinus samples after AXC were more acidotic (7.15 ± 0.14 vs. 7.32 ± 0.07, p = 0.001) and revealed higher CK-MB (21.0 ± 12.81 vs. 12.60 ± 11.80, p = 0.008) in HTK compared with IBC. The HTK had significantly a higher amount of erythrocyte suspension intraoperatively compared with IBC (0.21 ± 0.53 vs. 1.68 ± 0.93 U, p = 0.001). Microscopically, myocardial edema was more pronounced in HTK compared with IBC after AXC (2.25 ± 0.91 vs. 1.50 ± 0.04, p = 0.013). While a significant increase in the apoptotic index was seen after AXC in both groups (p = 0.001), no difference was detected between the groups (p = 0.417).

Conclusion IBC and HTK have a similar clinical outcome and protective effect, except for more pronounced myocardial edema and increased need for intraoperative transfusion with HTK.

Keywords

ischemia - histopathology - cardiac - myocardial protection

Authors' Contribution

K.A. and O.D. contributed equally to the manuscript. Both authors were involved in study design, collection of data, data analysis/interpretation, and writing of the manuscript.


* Both authors contriuted equally to this work.


Supplementary Material



Publication History

Received: 14 September 2022

Accepted: 02 November 2022

Article published online:
13 January 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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