title: Myocardial protection during aortic surgery: comparison between Bretschneider-HTK and cold blood cardioplegia.
abstract: The ideal cardioplegic strategy in thoracic aorta operations requiring long cardiopulmonary bypass and cross-clamp time has not been established. Suboptimal myocardial protection may lead to myocardial damage and possible post-operative complications. We evaluate post-operative cardiac Troponin I (cTnI) release, low cardiac output syndrome (LCOS) and mortality, using a cold crystalloid single-dose intracellular or cold blood multidose cardioplegia in 112 elective or emergent thoracic aorta operation patients. Fifty-four patients (HTK group) received Custodiol® cardioplegic solution and 58 received cold blood cardioplegia (CB group). Cross-clamp time, cardiopulmonary bypass (CPB) time and cTnI peak release were similar in both groups. No differences were found for atrial and ventricular arrhythmias, inotropic support, LCOS and in-hospital mortality. Two-way ANOVA analysis revealed an interactive effect on cTnI peak (p=0.012) of cardioplegic solution type across the cross-clamp time quintile. In the fifth quintile, cross-clamp time patient (>160 min) cTnI peak value was higher in CB patients (p=0.044). HTK and CB cardioplegic solutions assure similar myocardial protection in patients undergoing thoracic aorta operations. In long cross-clamp times, the lower post-operative cTnI release detected using HTK may be indicative of a better myocardial protection in these extreme conditions.
authors.affiliation: Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari, Bari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Scrascia
authors.forename: P
authors.initials: P
authors.lastname: Guida
authors.forename: C
authors.initials: C
authors.lastname: Rotunno
authors.forename: M
authors.initials: M
authors.lastname: De Palo
authors.forename: F
authors.initials: F
authors.lastname: Mastro
authors.forename: A
authors.initials: A
authors.lastname: Pignatelli
authors.forename: L
authors.initials: L
authors.lastname: de Luca Tupputi Schinosa
authors.forename: D
authors.initials: D
authors.lastname: Paparella
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000378:metabolism / Q000601:surgery*; D002303:Cardiac Output, Low / Q000097:blood / Q000401:mortality / Q000601:surgery*; D002314:Cardioplegic Solutions / Q000008:administration & dosage; D002315:Cardiopulmonary Bypass; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009206:Myocardium; D012189:Retrospective Studies; D019210:Troponin I / Q000097:blood
chemical_list: D002314:Cardioplegic Solutions; D019210:Troponin I