Multidose cold oxygenated blood is superior to a single dose of Bretschneider HTK-cardioplegia in the pig.
BACKGROUND
A single-dose strategy for cardioplegia is desired in minimal invasive approaches to valve surgery and aortic arch repairs. We hypothesized that a single infusion of Bretschneider HTK solution offers myocardial protection comparable to repeated cold oxygenated blood.


METHODS
Sixteen pigs on bypass with 60 minutes of aortic cross-clamping were randomized to a single dose of Custodiol (HTK group) or repeated oxygenated blood cardioplegia (CBC group). Left ventricular function and perfusion were evaluated by conductance catheter, echocardiography, and microspheres. Myocardial injury was assessed with serum troponin-T.


RESULTS
Baseline values showed no group differences. One hour after declamping cardiac index was reduced in the HTK group, 3.5 +/- 0.2 L x min(-1) x m(-2) (mean +/- standard error of the mean) compared with 4.7 +/- 0.4 L x min(-1) x m(-2) in the CBC group (p < 0.0005), decreasing to 4.0 +/- 0.2 and 3.9 +/- 0.2 L x min(-1) x m(-2) after 2 and 3 hours, respectively (p < 0.005 versus 1 hour). In the HTK group cardiac index remained low and unchanged. In the CBC group preload recruitable stroke work was 72.6 +/- 1.2 mm Hg 1 hour after declamping, decreasing to 65.2 +/- 2.5 and 60.3 +/- 3.9 mm Hg after 2 and 3 hours, respectively (p < 0.05 versus 1 hour). In the HTK group corresponding values after 1, 2, and 3 hours were low at 47.2 +/- 4.4, 48.4 +/- 4.2, and 50.7 +/- 4.3 mm Hg, respectively (p < 0.025 versus CBC for all). Subendocardial radial peak systolic strain averaged 80.5% +/- 4.8% after declamping in the CBC group versus 53.4% +/- 5.5% in the HTK group (p = 0.002). Serum troponin-T release was lower in the CBC group.


CONCLUSIONS
Repeated oxygenated blood cardioplegia provides better myocardial protection and preservation of left ventricular function than a single dose of HTK during the early hours after declamping.
Fannelop
Tord
T
Surgical Research Laboratory, Department of Surgical Sciences, University of Bergen, Bergen, Norway. tfan@online.no
Dahle
Geir Olav
GO
Salminen
Pirjo-Riitta
PR
Moen
Christian Arvei
CA
Matre
Knut
K
Mongstad
Arve
A
Eliassen
Finn
F
Segadal
Leidulf
L
Grong
Ketil
K