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Bulescu NC, Mitchell J, Metton O, El Jonhy N, Amaz C, Perouse de Montclos T, Lilot M, Mewton N, Henaine R. Celsior® vs. St Thomas® cardioplegia: analysis of myocardial protection and clinical safety in neonates. Front Pediatr 2024; 12:1430832. [PMID: 39040670 PMCID: PMC11260699 DOI: 10.3389/fped.2024.1430832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024] Open
Abstract
Objective To compare the effectiveness and safety of Celsior® crystalloid solution to St Thomas® solution as cardioplegia in pediatric arterial switch surgery. Methods A retrospective study was conducted on 180 patients who underwent arterial switch operation (ASO) between 2005 and 2019. The patients were divided into two groups: the St Thomas group receiving St Thomas solution and the Celsior® group receiving Celsior® solution. The study aimed to assess myocardial protection while evaluating clinical outcomes of patients between groups. Results Baseline characteristics not different between groups. The postoperative troponin release trends and blood lactate levels were not different between groups. However, the Celsior® group had a significant lower incidence of delayed sternal closure (9.7% vs. 19.5%; p = 0.09) and mechanical circulatory support (ECMO) (4.9% vs. 24.7%; p < 0.001) compared to the St Thomas group. The length of stay in the intensive care unit (ICU) was significantly shorter in the Celsior® group (4.6 ± 3.36 days vs. 8.72 ± 5.08 days, respectively; p < 0.001). There was no significant difference in 30-day mortality between the two groups (2.9% vs. 2.6%; p = 0.147). Conclusion The study suggests that Celsior® solution is effective and safe for myocardial protection in pediatric arterial switch surgery. It may offer potential benefits such as reduced need for delayed sternal closure and ECMO support, as well as shorter ICU stay. However, the study has limitations including its retrospective design and the use of different cardioplegic solutions during different time periods. Further prospective randomized trials are needed for confirmation. Clinical Registration Number ClinicalTrials.gov, ID: NCT04616222.
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Affiliation(s)
| | - Julia Mitchell
- Congenital Cardiac Surgery, Louis Pradel Hospital, Lyon, France
| | - Olivier Metton
- Congenital Cardiac Surgery, Louis Pradel Hospital, Lyon, France
| | - Naoual El Jonhy
- Center for Clinical Investigation, Louis Pradel Hospital, Lyon, France
| | - Camille Amaz
- Center for Clinical Investigation, Louis Pradel Hospital, Lyon, France
| | | | - Marc Lilot
- Pediatric Cardiac, Thoracic and Vascular Anesthesia and Intensive Care Unit, Louis Pradel Hospital, Lyon, France
| | - Nathan Mewton
- Center for Clinical Investigation, Louis Pradel Hospital, Lyon, France
| | - Roland Henaine
- Congenital Cardiac Surgery, Louis Pradel Hospital, Lyon, France
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Elmahrouk AF, Shihata MS, Al-Radi OO, Arafat AA, Altowaity M, Alshaikh BA, Galal MN, Bogis AA, Al Omar HY, Assiri WJ, Jamjoom AA. Custodiol versus blood cardioplegia in pediatric cardiac surgery: a randomized controlled trial. Eur J Med Res 2023; 28:404. [PMID: 37798628 PMCID: PMC10552411 DOI: 10.1186/s40001-023-01372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Blood-based cardioplegia is the standard myocardial protection strategy in pediatric cardiac surgery. Custadiol (histidine-tryptophan-ketoglutarate), an alternative, may have some advantages but is potentially less effective at myocardial protection. This study aimed to test whether custadiol is not inferior to blood-based cardioplegia in pediatric cardiac surgery. METHODS The study was designed as a randomized controlled trial with a blinded outcome assessment. All pediatric patients undergoing cardiac surgery with cardiopulmonary bypass and cardioplegia, including neonates, were eligible. Emergency surgery was excluded. The primary outcome was a composite of death within 30 days, an ICU stay longer than 5 days, or arrhythmia requiring intervention. Secondary endpoints included total hospital stay, inotropic score, cardiac troponin levels, ventricular function, and extended survival postdischarge. The sample size was determined a priori for a noninferiority design with an expected primary outcome of 40% and a clinical significance difference of 20%. RESULTS Between January 2018 and January 2021, 226 patients, divided into the Custodiol cardioplegia (CC) group (n = 107) and the blood cardioplegia (BC) group (n = 119), completed the study protocol. There was no difference in the composite endpoint between the CC and BC groups, 65 (60.75%) vs. 71 (59.66%), respectively (P = 0.87). The total length of stay in the hospital was 14 (Q2-Q3: 10-19) days in the CC group vs. 13 (10-21) days in the BC group (P = 0.85). The inotropic score was not significantly different between the CC and BC groups, 5 (2.6-7.45) vs. 5 (2.6-7.5), respectively (P = 0.82). The cardiac troponin level and ventricular function did not differ significantly between the two groups (P = 0.34 and P = 0.85, respectively). The median duration of follow-up was 32.75 (Q2-Q3: 18.73-41.53) months, and there was no difference in survival between the two groups (log-rank P = 0.55). CONCLUSIONS Custodial cardioplegia is not inferior to blood cardioplegia for myocardial protection in pediatric patients. Trial registration The trial was registered in Clinicaltrials.gov, and the ClinicalTrials.gov Identifier number is NCT03082716 Date: 17/03/2017.
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Affiliation(s)
- Ahmed F Elmahrouk
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Centre,, MBC J-16, P.O. Box: 40047, 21499, Jeddah, Saudi Arabia.
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
| | - Mohammad S Shihata
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Centre,, MBC J-16, P.O. Box: 40047, 21499, Jeddah, Saudi Arabia
| | - Osman O Al-Radi
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Centre,, MBC J-16, P.O. Box: 40047, 21499, Jeddah, Saudi Arabia
- Department of Surgery, Cardiac Surgery Section, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Musleh Altowaity
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Centre,, MBC J-16, P.O. Box: 40047, 21499, Jeddah, Saudi Arabia
| | - Bayan A Alshaikh
- Cardiac Surgery Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Mohamed N Galal
- Pediatric Cardiac Surgery Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdulbadee A Bogis
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Centre,, MBC J-16, P.O. Box: 40047, 21499, Jeddah, Saudi Arabia
| | - Haneen Y Al Omar
- Research Centre, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Wesal J Assiri
- Department of Nursing, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Centre,, MBC J-16, P.O. Box: 40047, 21499, Jeddah, Saudi Arabia
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3
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Cardioplegia in Open Heart Surgery: Age Matters. J Clin Med 2023; 12:jcm12041698. [PMID: 36836232 PMCID: PMC9958799 DOI: 10.3390/jcm12041698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Cardioplegia is a pharmacological approach essential for the protection of the heart from ischemia-reperfusion (I-R) injury. Over the years, numerous cardioplegic solutions have been developed, with each cardioplegic approach having its advantages and disadvantages. Cardioplegic solutions can be divided into crystalloid and blood cardioplegic solutions, and an experienced surgeon chooses the type of solution based on the individual needs of patients in order to provide optimal heart protection. Importantly, the pediatric immature myocardium is structurally, physiologically, and metabolically different from the adult heart, and consequently its needs to achieve cardioplegic arrest strongly differ. Therefore, the present review aimed to provide a summary of the cardioplegic solutions available to pediatric patients with a special focus on emphasizing differences in heart injury after various cardioplegic solutions, the dosing strategies, and regimens. MATERIAL AND METHODS The PubMed database was searched using the terms cardioplegia, I-R, and pediatric population, and studies that investigated the influence of cardioplegic strategies on markers of cardiac muscle damage were further analyzed in this review. CONCLUSIONS A large body of evidence suggested more prominent benefits achieved with blood compared to those with crystalloid cardioplegia in pediatric myocardium preservation. However, standardized and uniform protocols have not been established so far, and an experienced surgeon chooses the type of cardioplegia solution based on the individual needs of patients, while the severity of myocardial damage strongly depends on the type and duration of the surgical procedure, overall patient condition, and presence of comorbidities, etc.
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Yang X, Huang W, Zhan D, Ren D, Ji H, Liu Z, Wang Q, Zhang N, Zhang Z. Biodegradability and Cytocompatibility of 3D-Printed Mg-Ti Interpenetrating Phase Composites. Front Bioeng Biotechnol 2022; 10:891632. [PMID: 35837550 PMCID: PMC9274132 DOI: 10.3389/fbioe.2022.891632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Orthopedic hybrid implants combining both titanium (Ti) and magnesium (Mg) have gained wide attraction nowadays. However, it still remains a huge challenge in the fabrication of Mg-Ti composites because of the different temperatures of Ti melting point and pure Mg volatilization point. In this study, we successfully fabricated a new Mg-Ti composite with bi-continuous interpenetrating phase architecture by infiltrating Mg melt into Ti scaffolds, which were prepared by 3D printing and subsequent acid treatment. We attempted to understand the 7-day degradation process of the Mg-Ti composite and examine the different Mg2+ concentration composite impacts on the MC3T3-E1 cells, including toxicity, morphology, apoptosis, and osteogenic activity. CCK-8 results indicated cytotoxicity and absence of the Mg-Ti composite during 7-day degradation. Moreover, the composite significantly improved the morphology, reduced the apoptosis rate, and enhanced the osteogenic activity of MC3T3-E1 cells. The favorable impacts might be attributed to the appropriate Mg2+ concentration of the extracts. The results on varying Mg2+ concentration tests indicated that Mg2+ showed no cell adverse effect under 10-mM concentration. The 8-mM group exhibited the best cell morphology, minimum apoptosis rate, and maximum osteogenic activity. This work may open a new perspective on the development and biomedical applications for Mg-Ti composites.
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Affiliation(s)
- Xixiang Yang
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Wanyi Huang
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Desong Zhan
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| | - Dechun Ren
- Shi-Changxu Innovation Center for Advanced Materials, Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
| | - Haibin Ji
- Shi-Changxu Innovation Center for Advanced Materials, Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
| | - Zengqian Liu
- Shi-Changxu Innovation Center for Advanced Materials, Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
| | - Qiang Wang
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
- *Correspondence: Qiang Wang, ; Ning Zhang,
| | - Ning Zhang
- School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
- *Correspondence: Qiang Wang, ; Ning Zhang,
| | - Zhefeng Zhang
- Shi-Changxu Innovation Center for Advanced Materials, Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
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Kirişci M, Koçarslan A, Altintaş Aykan D, Alkan Baylan F, Doğaner A, Orak Y. Evaluation of the cardioprotective effects of crystalloid del Nido cardioplegia solution via a rapid and accurate cardiac marker: heart-type fatty acid-binding protein. Turk J Med Sci 2020; 50:999-1006. [PMID: 32394686 PMCID: PMC7379457 DOI: 10.3906/sag-2002-53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/10/2020] [Indexed: 01/18/2023] Open
Abstract
Background/aim Our aim in this study was to compare the efficacy and safety of crystalloid del Nido solution and cold blood cardioplegia solution on clinical and laboratory parameters. Materials and methods Sixty patients who underwent elective coronary bypass operation between July 2019 and January 2020 were included in our study. Patients were divided into 2 groups of 30 patients using del Nido solution (DNS) and cold blood cardioplegia solution (CBCS), which were given for cardiac arrest. Demographic data, preoperative, postoperative 0th h, 6th h and 4th day creatine kinase myocardial band (CK-MB) and troponin I values were compared with a specific cardiac enzyme heart-type fatty acid-binding protein (H-FABP). Results We found that aortic cross clamp duration and cardiopulmonary bypass (CPB) time were shorter in patients using del Nido solution than cold blood cardioplegia solution (57.30 ± 23.57 min, 76.07 ± 27.18 min, P = 0.006) (95.07 ± 23.06 min, 114.13 ± 33.93, P = 0.014). Total cardioplegia solution volume was higher in the cold blood cardioplegia solution group (1426.67 ± 416.00 vs. 1200 ± 310.73 P = 0.02). Preoperative and postoperative levels of cardiac enzymes including CK-MB, troponin I and H-FABP were comparable in del Nido solution and cold blood cardioplegia solution groups. Conclusion According to these results, when we compare both demographic data and CK-MB, troponin I and H-FABP levels, both cardioplegia solutions were comparable regarding safety and efficacy in terms of myocardial protection.
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Affiliation(s)
- Mehmet Kirişci
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Aydemir Koçarslan
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Duygun Altintaş Aykan
- Department of Pharmacology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Filiz Alkan Baylan
- Department of Biochemistry, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Adem Doğaner
- Department of Biostatistics, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Yavuz Orak
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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Pérez-Andreu J, Fernández-Doblas J, Sao Avilés A, de la Torre García T, Roses Noguer F, Abella RF. Myocardial protection in the arterial switch operation: Custodiol versus cold blood cardioplegia. Interact Cardiovasc Thorac Surg 2020; 30:136-143. [PMID: 31873745 DOI: 10.1093/icvts/ivz216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/09/2019] [Accepted: 08/11/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The optimal myocardial protective solution in the neonatal arterial switch operation remains controversial. The aim of this study was to demonstrate that Bretschneider's histidine-tryptophan-ketoglutarate crystalloid solution (Custodiol) offers protection at least similar to that of cold blood cardioplegia. METHODS Patients who underwent the neonatal arterial switch operation with Custodiol between January 2016 and December 2018 (n = 23) were compared with an historical cohort from August 2010 to December 2015 in which cold blood cardioplegia was used (n = 41). A linear mixed-effect model for repeated measures was performed to test the recovery of myocardial function based on inotropic and vasoactive inotropic scores, cardiac enzyme release and left ventricular ejection fraction. RESULTS Patients in the cold blood cardioplegia group had higher inotropic scores in the first 24 h (0 h, P = 0.001 and 24 h, P = 0.006) and higher vasoactive inotropic scores in the first 72 h (0 h, 24 h and 48 h, P < 0.001; 72 h, P = 0.012). Cardiac troponin-I concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-72 (1 h, 6 h, 12 h and 24 h, P < 0.001; 48 h, P = 0.001 and 72 h, P = 0.003). Creatinine-kinase-MB concentrations were higher in the cold blood cardioplegia group at postoperative hours 1-24 (1 h, 6 h and 12 h, P < 0.001; 24 h, P = 0.042). The left ventricular ejection fraction was higher in the Custodiol group just after the operation (P = 0.005), at 24 h (P = 0.001) and on the first day without inotropic support (P = 0.011). CONCLUSIONS Neonatal myocardium protected with Custodiol during the arterial switch operation presented optimal ventricular function recovery with less inotropic support and less myocardial damage compared with cold blood cardioplegia.
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Affiliation(s)
- Joaquín Pérez-Andreu
- Paediatric Cardiac Surgery Department, Vall d´Hebron University Hospital, Barcelona, Spain
| | | | - Augusto Sao Avilés
- Biostatistics, Cardiology Department, Vall d´Hebron University Hospital, Barcelona, Spain
| | | | - Ferrán Roses Noguer
- Paediatric Cardiology Department, Vall d´Hebron University Hospital, Barcelona, Spain
| | - Raúl F Abella
- Paediatric Cardiac Surgery Department, Vall d´Hebron University Hospital, Barcelona, Spain
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Bibevski S, Mendoza L, Ruzmetov M, Tayon K, Alkon J, Vandale B, Scholl F. Custodiol cardioplegia solution compared to cold blood cardioplegia in pediatric cardiac surgery: a single-institution experience. Perfusion 2019; 35:316-322. [PMID: 31581896 DOI: 10.1177/0267659119878006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Custodiol is an intracellular, crystalloid cardioplegia solution that is a single-dose alternative to multi-dose cold blood cardioplegia; however, there is scarce data regarding its use in infants and children. The objective of this study was to compare its impact on myocardial function in infants. METHODS Single-center retrospective review including 132 patients <12 months old undergoing biventricular repair. There were 106 patients who received single-dose Custodiol and 27 patients who received multi-dose blood cardioplegia. Demographic and echocardiographic data were compared between the two groups. RESULTS Patients receiving Custodiol were slightly younger (100 ± 62 days) and lower weight (4.7 ± 1.3 kg) compared to 152 ± 86 days and 5.2 ± 1.3 kg for blood cardioplegia (p < 0.05). The Society of Thoracic Surgeons/European Association for Cardio-Thoracic Surgery Congenital Heart Surgery score was similar between both groups. Average cardiopulmonary bypass time was similar between both groups (Custodiol 93 ± 54 minutes vs. blood 81 ± 44 minutes, p = 0.46) as was aortic cross-clamp time (Custodiol 58 ± 33 minutes vs. cold blood 53 ± 33 minutes, p = 0.62). Pre-operative left ventricular ejection fraction was similar for blood 73 ± 8% versus Custodiol 70 ± 9%, p = 0.21. There was also no intergroup difference in left ventricular ejection fraction 24 hours post op (blood 64 ± 9% vs. Custodiol 65 ± 12%, p = 0.53) or at discharge (blood 66 ± 10% vs. Custodiol 66 ± 11%, p = 0.95). The pre-operative right ventricle function by fractional area change was also similar in blood cardioplegia (46 ± 13%) versus Custodiol (48 ± 9%, p = 0.38) and showed similar drops in parameters in the two groups 24 hours after surgery and at discharge. CONCLUSION Single-dose Custodiol is as safe as blood cardioplegia for myocardial protection in congenital cardiac surgery for the cross-clamp times evaluated in this study. Evaluation at longer cross-clamp times would be helpful to determine if there is a greater benefit to single-dose Custodiol versus more repeated doses of blood cardioplegia for longer cross-clamp times.
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Affiliation(s)
- Steven Bibevski
- Joe DiMaggio Children's Hospital Heart Institute, Hollywood, FL, USA
| | - Laura Mendoza
- Joe DiMaggio Children's Hospital Heart Institute, Hollywood, FL, USA
| | - Mark Ruzmetov
- Joe DiMaggio Children's Hospital Heart Institute, Hollywood, FL, USA
| | - Kevin Tayon
- Joe DiMaggio Children's Hospital Heart Institute, Hollywood, FL, USA
| | - Jaime Alkon
- Joe DiMaggio Children's Hospital Heart Institute, Hollywood, FL, USA
| | - Breanna Vandale
- Joe DiMaggio Children's Hospital Heart Institute, Hollywood, FL, USA
| | - Frank Scholl
- Joe DiMaggio Children's Hospital Heart Institute, Hollywood, FL, USA
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Dolcino A, Gaudin R, Pontailler M, Raisky O, Vouhé P, Bojan M. Single-Shot Cold Histidine-Tryptophan-Ketoglutarate Cardioplegia for Long Aortic Cross-Clamping Durations in Neonates. J Cardiothorac Vasc Anesth 2019; 34:959-965. [PMID: 31543295 DOI: 10.1053/j.jvca.2019.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE More than 30% of European pediatric cardiac surgery centers use single-dose cold histidine-tryptophan-ketoglutarate cardioplegia (Custodiol; Dr Franz Köhler Chemie GmbH, Bensheim, Germany). In neonates with transposition of the great arteries, arterial switch surgery (ASO) implies aortic division, and it is unknown whether repeated ostial cannulation causes intimal insult and affects long-term results, and therefore, single-dose Custodiol is appealing. The present study investigated the association among myocardial no-flow duration, postoperative troponins, and postoperative outcomes in neonates undergoing ASO with Custodiol cardioplegia. DESIGN Retrospective analysis of the association among myocardial no-flow duration, postoperative troponin release (concentration magnitude × measurement duration within 48 h), and outcomes using stratification according to coronary anatomy and attending surgeon. SETTING Single-institutional, tertiary pediatric cardiac surgery unit of a university hospital. PARTICIPANTS The study comprised 101 neonates undergoing ASO. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The mean age of patients was 6.1 ± 5.4 days, the cardiopulmonary bypass duration was 108.7 ± 54.1 minutes, the temperature during cross-clamping was 31.1°C ± 1.7°C, the duration of mechanical ventilation was 4 (3-6) days, the length of intensive care unit stay was 7 (5-8) days, delayed sternal closure occurred in 32 (31.7%) patients, and no patients died. The myocardial no-flow duration averaged 62.3 ± 14.6 minutes and was linked with both troponin release (p = 0.04) and low cardiac output syndrome, as assessed by the requirement for delayed sternal closure (p = 0.03), regardless of cardiopulmonary bypass duration and temperature. Eighty-two percent of the patients with myocardial no-flow duration >74 minutes necessitated delayed sternal closure. CONCLUSIONS Single-dose Custodiol may be inadequate for prolonged cross-clamping durations without myocardial perfusion in neonates.
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Affiliation(s)
- Andrea Dolcino
- Department of Anesthesiology and Critical Care, Necker-Enfants Malades University Hospital, Paris, France
| | - Regis Gaudin
- Department of Pediatric Cardiac Surgery, Necker-Enfants Malades University Hospital, Paris, France
| | - Margaux Pontailler
- Department of Pediatric Cardiac Surgery, Necker-Enfants Malades University Hospital, Paris, France; Paris Descartes University, Paris, France
| | - Olivier Raisky
- Department of Pediatric Cardiac Surgery, Necker-Enfants Malades University Hospital, Paris, France; Paris Descartes University, Paris, France
| | - Pascal Vouhé
- Department of Pediatric Cardiac Surgery, Necker-Enfants Malades University Hospital, Paris, France; Paris Descartes University, Paris, France
| | - Mirela Bojan
- Department of Anesthesiology, Congenital Cardiac Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France.
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Valente AS, Lustosa GP, Mota LAM, Lima A, Mesquita FAD, Gondim A, Rodrigues FA, Pompeu RG, Branco KC. Comparative Analysis of Myocardial Protection with HTK Solution and Hypothermic Hyperkalemic Blood Solution in the Correction of Acyanogenic Congenital Cardiopathies - A Randomized Study. Braz J Cardiovasc Surg 2019; 34:271-278. [PMID: 31310464 PMCID: PMC6629237 DOI: 10.21470/1678-9741-2018-0243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The goal of the present study was to compare the myocardial protection obtained with histidine-tryptophan-ketoglutarate (HTK) cardioplegic solution (Custodiol®) and with intermittent hypothermic blood solution. METHODS Two homogenous groups of 25 children with acyanotic congenital heart disease who underwent total correction with mean aortic clamping time of 60 minutes were evaluated in this randomized study. Troponin and creatine kinase-MB curves, vasoactive-inotropic score, and left ventricular function were obtained by echocardiogram in each group. The values were correlated and presented through graphs and tables after adequate statistical treatment. RESULTS It was observed that values of all the studied variables varied over time, but there was no difference between the groups. CONCLUSION We conclude that in patients with acyanotic congenital cardiopathies submitted to total surgical correction, mean aortic clamping time around one hour, and cardiopulmonary bypass with moderate hypothermia, the HTK crystalloid cardioplegic solution offers the same myocardial protection as the cold-blood hyperkalemic cardioplegic solution analyzed, according to the variables considered in our study model.
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Affiliation(s)
- Acrisio Sales Valente
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes Department of Surgery Fortaleza Ceará Brazil Department of Surgery, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil.,Centro Universitário Unichristus Fortaleza Ceará Brazil Centro Universitário Unichristus, Fortaleza, Ceará, Brazil
| | - Gustavo Porto Lustosa
- Centro Universitário Unichristus Fortaleza Ceará Brazil Centro Universitário Unichristus, Fortaleza, Ceará, Brazil
| | - Lia Alves Martins Mota
- Centro Universitário Unichristus Fortaleza Ceará Brazil Centro Universitário Unichristus, Fortaleza, Ceará, Brazil
| | - Adriano Lima
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes Department of Surgery Fortaleza Ceará Brazil Department of Surgery, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Fernando Antônio de Mesquita
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes Department of Surgery Fortaleza Ceará Brazil Department of Surgery, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Aloísio Gondim
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes Department of Surgery Fortaleza Ceará Brazil Department of Surgery, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Fábio Alércio Rodrigues
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes Department of Surgery Fortaleza Ceará Brazil Department of Surgery, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Ronald Guedes Pompeu
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes Department of Congenital Heart Disease Fortaleza Ceará Brazil Department of Congenital Heart Disease, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Klébia Castelo Branco
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes Department of Congenital Heart Disease Fortaleza Ceará Brazil Department of Congenital Heart Disease, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
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Gatti G, Rauber E, Forti G, Benussi B, Gabrielli M, Gripari C, Gustin G, Pappalardo A. Safe cross-clamp time using Custodiol ®-histidine-tryptophan-ketoglutarate cardioplegia in the adult. Perfusion 2019; 34:568-577. [PMID: 30919738 DOI: 10.1177/0267659119837824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Safe cross-clamp time using single-dose Custodiol®-histidine-tryptophan-ketoglutarate cardioplegia has not been established conclusively. METHODS Immediate post-operative outcomes of 1,420 non-consecutive, cardiac surgery patients were reviewed retrospectively. Predictors of a combined endpoint made of in-hospital mortality and any major complication post-surgery were found with the multivariable method. Analysis of variance was used to evaluate the impact of cross-clamp time on most relevant complications. Discriminatory power and cut-off value of cross-clamp time were established for in-hospital mortality and each of the major complications (receiver operating characteristic curve analysis). A comparative analysis (with propensity matching) with multidose cold blood cardioplegia on in-hospital mortality post-surgery was performed in non-coronary surgery patients. RESULTS Coronary, aortic valve and mitral valve surgery and surgery on thoracic aorta were performed in 45.4%, 41.9%, 49.5%, 20.6% of cases, respectively. In-hospital mortality and the rate of any major complication post-surgery were 6.5% and 41.9%, respectively. Cross-clamp time had significant impact on in-hospital mortality and almost all major post-operative complications, except neurological dysfunctions (p = 0.084), myocardial infarction (p = 0.12) and mesenteric ischaemia (p = 0.85). Areas under the receiver operating characteristic curve and the optimal cut-off values for in-hospital mortality and any major complication were of 0.657, 0.594, >140 and >127 minutes, respectively. Comorbidities-adjusted odds ratio for any major complication of cross-clamp time <127 minutes was 1.86 (p < 0.0001). Despite similar in-hospital mortality (p = 0.57), there was an earlier significant increase of mortality in Custodiol-HTK than in multidose cold blood propensity-matched, non-coronary surgery patients. CONCLUSIONS The use of Custodiol-HTK cardioplegia is associated with a low risk of serious post-operative complications provided that cross-clamp time is of 2 hours or less.
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Affiliation(s)
- Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Elisabetta Rauber
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Gabriella Forti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Bernardo Benussi
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Marco Gabrielli
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Carla Gripari
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Gianfranco Gustin
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
| | - Aniello Pappalardo
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Ospedale di Cattinara, University Hospital of Trieste, Trieste, Italy
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11
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Talwar S, Chatterjee S, Sreenivas V, Makhija N, Kapoor PM, Choudhary SK, Airan B. Comparison of del Nido and histidine-tryptophan-ketoglutarate cardioplegia solutions in pediatric patients undergoing open heart surgery: A prospective randomized clinical trial. J Thorac Cardiovasc Surg 2019; 157:1182-1192.e1. [DOI: 10.1016/j.jtcvs.2018.09.140] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 10/27/2022]
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12
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Busro PW, Romolo H, Sastroasmoro S, Rachmat J, Sadikin M, Santoso A, Boom CE, Suwarto S, Jusuf AA. Role of terminal warm blood cardioplegia in complex congenital heart surgery. Asian Cardiovasc Thorac Ann 2018; 26:196-202. [PMID: 29448828 DOI: 10.1177/0218492318759105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Myocardial protection is vital to ensure successful open heart surgery. Cardioplegic solution is one method to achieve good myocardial protection. Inevitably, ischemia-reperfusion injury occurs with aortic crossclamping. Histidine-tryptophan-ketoglutarate solution is a frequently used cardioplegia for complex congenital heart surgery. We postulated that addition of terminal warm blood cardioplegia before removal of the aortic crossclamp might improve myocardial protection. Method A randomized controlled trial was conducted on 109 cyanotic patients aged, 1 to 5 years who underwent complex biventricular repair. They were divided into a control group of 55 patients who had histidine-tryptophan-ketoglutarate only and a treatment group of 54 who had histidine-tryptophan-ketoglutarate with terminal warm blood cardioplegia. Endpoints were clinical parameters, troponin I levels, and caspase-3 as an apoptosis marker. Results The incidence of low cardiac output syndrome was 34%, with no significant difference between groups (35.2% vs. 33.3%, p = 0.84). The incidence of arrhythmias in our treatment group was lower compared to the control group (36% vs. 12%, p = 0.005). Troponin I and caspase-3 results did not show any significant differences between groups. For cases with Aristotle score ≥ 10, weak expression of caspase-3 in the treatment group post-cardiopulmonary bypass was lower compared to the control group. Conclusion For complex congenital cardiac surgery, the addition of terminal warm blood cardioplegia does not significantly improve postoperative clinical or metabolic markers.
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Affiliation(s)
- Pribadi Wiranda Busro
- 1 Department of Pediatric Cardiac Surgery, Rumah Sakit Jantung dan Pembuluh Darah Nasional Harapan Kita, Jakarta, Indonesia
| | - Harvey Romolo
- 1 Department of Pediatric Cardiac Surgery, Rumah Sakit Jantung dan Pembuluh Darah Nasional Harapan Kita, Jakarta, Indonesia
| | - Sudigdo Sastroasmoro
- 2 Department of Pediatrics, 95338 Rumah Sakit Cipto Mangunkusumo, Jakarta , Indonesia
| | - Jusuf Rachmat
- 3 Department of Pediatric Cardiac Surgery, Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia
| | - Mohammad Sadikin
- 4 Department of Biochemistry, Faculty of Medicine 95338 Universitas Indonesia , Jakarta, Indonesia
| | - Anwar Santoso
- 5 Department of Cardiology, Rumah Sakit Jantung dan Pembuluh Darah Nasional Harapan Kita, Jakarta, Indonesia
| | - Cindy Elfira Boom
- 6 Department of Anesthesiology, Rumah Sakit Jantung dan Pembuluh Darah Nasional Harapan Kita, Jakarta, Indonesia
| | - Suhendro Suwarto
- 7 Department of Internal Medicine, 95338 Rumah Sakit Cipto Mangunkusumo , Jakarta, Indonesia
| | - Ahmad Aulia Jusuf
- 8 Department of Histology, Faculty of Medicine 95338 Universitas Indonesia , Jakarta, Indonesia
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Mylonas KS, Tzani A, Metaxas P, Schizas D, Boikou V, Economopoulos KP. Blood Versus Crystalloid Cardioplegia in Pediatric Cardiac Surgery: A Systematic Review and Meta-analysis. Pediatr Cardiol 2017; 38:1527-1539. [PMID: 28948337 DOI: 10.1007/s00246-017-1732-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/13/2017] [Indexed: 01/01/2023]
Abstract
The benefit of blood cardioplegia (BCP) compared to crystalloid cardioplegia (CCP) is still debatable. Our aim was to systematically review and synthesize all available evidence on the use of BCP and CCP to assess if any modality provides superior outcomes in pediatric cardiac surgery. A systematic literature search of the PubMed and Cochrane databases was performed with respect to the PRISMA statement (end-of-search date: January 30th, 2017). We extracted data on study design, demographics, cardioplegia regimens, and perioperative outcomes as well as relevant biochemical markers, namely cardiac troponin I (cTnI), lactate, and ATP levels at baseline, after reperfusion and postoperatively at 1, 4, 12, and 24 h as applicable. Data were appropriately pooled using random and mixed effects models. Our systematic review includes 56 studies reporting on a total of 7711 pediatric patients. A meta-analysis of the 10 eligible studies directly comparing BCP (n = 416) to CCP (n = 281) was also performed. There was no significant difference between the two groups with regard to cTnI and Lac at any measured time point, ATP levels after reperfusion, length of intensive care unit stay (WMD: -0.08, 95% CI -1.52 to 1.36), length of hospital stay (WMD: 0.13, 95% CI -0.85 to 1.12), and 30-day mortality (OR 1.11, 95% CI 0.43-2.88). Only cTnI levels at 4 h postoperatively were significantly lower with BCP (WMD: -1.62, 95% CI -2.07 to -1.18). Based on the available data, neither cardioplegia modality seems to be superior in terms of clinical outcomes, ischemia severity, and overall functional recovery.
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Affiliation(s)
- Konstantinos S Mylonas
- Division of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Warren 11, 55 Fruit Street, Boston, MA, 02114, USA. .,Surgery Working Group, Society of Junior Doctors, Athens, Greece.
| | - Aspasia Tzani
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Dimitrios Schizas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos P Economopoulos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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14
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Lin YZ, Huang JB, Li XW, Tang XM, Lu WJ, Wen ZK, Liang J, Li DY, Wang H. Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution. Exp Ther Med 2017; 14:2677-2682. [PMID: 28962211 DOI: 10.3892/etm.2017.4814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/18/2016] [Indexed: 11/06/2022] Open
Abstract
Cardioplegic reperfusion during a long-term ischemic period interrupts cardiac surgery and increases cellular edema due to repeated administration. The present clinical study compared the protective effects of histidine-ketoglutarate-tryptophan (HTK) solution and St. Thomas crystalloid cardioplegia. Clinical experiences of the myocardial protection induced by one single perfusion with HTK were reviewed in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease. This retrospective study included 88 high-risk patients (aortic cross-clamp time, >120 min) between March 2001 and July 2012. The cohort was divided into two groups according to the technique used. Either myocardial protection was performed with one single perfusion with HTK solution (HTK group) or with conventional St. Thomas crystalloid cardioplegia (St group). The duration of cardiopulmonary bypass did not differ between the two groups. The mortality, morbidity, intensive care unit (ICU) stay, postoperative hospitalization, and transfusions of HTK group are significantly lower than those of the St group (P<0.05). Univariate and multivariate analysis demonstrated that HTK is a statistically significant independent predictor of decreased early mortality and morbidity (P<0.05). In conclusion, the present findings suggested that HTK solution decreases mortality, morbidity, ICU stay, postoperative hospitalization, and transfusions in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease.
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Affiliation(s)
- Ying-Zhong Lin
- Department of Cardiothoracic Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
| | - Jing-Bin Huang
- Department of Cardiothoracic Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China.,Department of Cardiothoracic Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi 530011, P.R. China
| | - Xiang-Wei Li
- Department of Cardiothoracic Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
| | - Xian-Ming Tang
- Department of Cardiothoracic Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
| | - Wei-Jun Lu
- Department of Cardiothoracic Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
| | - Zhao-Ke Wen
- Department of Cardiothoracic Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
| | - Jian Liang
- Department of Cardiothoracic Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi 530011, P.R. China
| | - Dian-Yuan Li
- Pediatric Center of Cardiac Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Hao Wang
- Department of Cardiothoracic Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, P.R. China
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15
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Talwar S, Bhoje A, Sreenivas V, Makhija N, Aarav S, Choudhary SK, Airan B. Comparison of del Nido and St Thomas Cardioplegia Solutions in Pediatric Patients: A Prospective Randomized Clinical Trial. Semin Thorac Cardiovasc Surg 2017; 29:366-374. [DOI: 10.1053/j.semtcvs.2017.08.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 11/11/2022]
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16
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Li XW, Lin YZ, Lin H, Huang JB, Tang XM, Long XM, Lu WJ, Wen ZK, Liang J, Li DY, Zhao XF. Histidine-tryptophan-ketoglutarate solution decreases mortality and morbidity in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease: an 11-year experience from a single institution. ACTA ACUST UNITED AC 2016; 49:e5208. [PMID: 27191607 PMCID: PMC4869826 DOI: 10.1590/1414-431x20165208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/11/2016] [Indexed: 11/25/2022]
Abstract
Cardioplegic reperfusion during a long term ischemic period interrupts cardiac
surgery and also increases cellular edema due to repeated solution administration. We
reviewed the clinical experiences on myocardial protection of a single perfusion with
histidine-tryptophan-ketoglutarate (HTK) for high-risk patients with severe pulmonary
arterial hypertension associated with complex congenital heart disease. This
retrospective study included 101 high-risk patients undergoing arterial switch
operation between March 2001 and July 2012. We divided the cohort into two groups:
HTK group, myocardial protection was carried out with one single perfusion with HTK
solution; and St group, myocardial protection with conventional St. Thomas'
crystalloid cardioplegic solution. The duration of cardiopulmonary bypass did not
differ between the two groups. The mortality, morbidity, ICU stay, post-operative
hospitalization time, and number of transfusions in HTK group were lower than those
in St group (P<0.05). Univariate and multivariate analysis showed that HTK is a
statistically significant independent predictor of decreased early mortality and
morbidity (P<0.05). In conclusion, HTK solution seems to be an effective and safe
alternative to St. Thomas' solution for cardioplegic reperfusion in high-risk
patients with complex congenital heart disease.
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Affiliation(s)
- X W Li
- Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China
| | - Y Z Lin
- Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China
| | - H Lin
- Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China
| | - J B Huang
- Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China
| | - X M Tang
- Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China
| | - X M Long
- Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China
| | - W J Lu
- Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China
| | - Z K Wen
- Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China
| | - J Liang
- Ruikang Hospital, Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China
| | - D Y Li
- Chinese Academy of Medical Sciences and Peking Union Medical College, Pediatric Center of Cardiac Surgery, Cardiovascular Institute and Fuwai Hospital, Beijing, China
| | - X F Zhao
- Ruikang Hospital, Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China
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Qulisy EA, Fakiha A, Debis RS, Jamjoom AA, Elassal AA, Al-Radi OO. Custodiol versus blood cardioplegia in pediatric cardiac surgery, two-center study. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jescts.2016.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Momeni M, Poncelet A, Rubay J, Matta A, Veevaete L, Detaille T, Houtekie L, Clement de Clety S, Derycke E, Moniotte S, Sluysmans T, Veyckemans F. Does Postoperative Cardiac Troponin-I Have Any Prognostic Value in Predicting Midterm Mortality After Congenital Cardiac Surgery? J Cardiothorac Vasc Anesth 2016; 31:122-127. [PMID: 27431598 DOI: 10.1053/j.jvca.2016.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study evaluated the prognostic value of postoperative cardiac troponin-I (cTnI) in predicting all-cause mortality up to 3 months after normothermic congenital cardiac surgery. DESIGN Prospective observational study. SETTING University hospital. PARTICIPANTS All children ages 0 to 10 years. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS cTnI was measured after the induction of anesthesia but before the surgery, at the pediatric intensive care unit arrival, and at 4, 12, and 24 hours postoperatively. Follow-up was extended up to 6 months. Overall, 169 children were analyzed, of whom 165 were survivors and 4 were nonsurvivors. cTnI levels were significantly higher in nonsurvivors only at 24 hours (p = 0.047). Children undergoing surgery with cardiopulmonary bypass (CPB) had significantly higher cTnI concentrations compared with those without CPB (p<0.001). Logistic regression analysis was performed on the 146 children in the CPB group with the following predictive variables: CPB time, postoperative cTnI concentrations, the presence of a cyanotic malformation, and intramyocardial incision. None of the variables predicted mortality. Postoperative cTnI concentrations did not predict 6 months׳ mortality. Only cTnI at 24 hours predicted the length of stay in the pediatric intensive care unit. CONCLUSIONS This study did not find that postoperative cTnI concentration predicted midterm mortality after normothermic congenital heart surgery. (ClinicalTrials.gov identifier: NCT01616394).
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Affiliation(s)
- Mona Momeni
- Department of Anesthesiology, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium.
| | - Alain Poncelet
- Department of Cardiac Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Jean Rubay
- Department of Cardiac Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Amine Matta
- Department of Anesthesiology, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Laurent Veevaete
- Department of Anesthesiology, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Thierry Detaille
- Pediatrics Intensive Care Unit, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Laurent Houtekie
- Pediatrics Intensive Care Unit, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Stéphan Clement de Clety
- Pediatrics Intensive Care Unit, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Emilien Derycke
- Pediatrics Intensive Care Unit, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Stéphane Moniotte
- Department of Pediatrics, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Thierry Sluysmans
- Department of Pediatrics, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Francis Veyckemans
- Department of Anesthesiology, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
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Ferguson ZG, Yarborough DE, Jarvis BL, Sistino JJ. Evidence-based medicine and myocardial protection — where is the evidence? Perfusion 2014; 30:415-22. [DOI: 10.1177/0267659114551856] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Myocardial protection with cardioplegia is an integral component of most cardiac surgical procedures, providing protection of the heart by limiting metabolic activity and increasing the myocardium’s capacity to withstand ischemia for prolonged periods of time. Cardioplegia has greatly affected the landscape of cardiothoracic surgery since its introduction in the 1960s, but, to this day, there continues to be a debate over what the ideal cardioplegic solution should be. The goal of this analysis is to describe current practices in cardioplegia and to point out the lack of quality human research and subsequent publications that prevent best practices from being utilized. Methods: This study is a systematic review of journal publications pertaining to the composition of commonly used cardioplegic solutions. Four main types of cardioplegia were assessed to give a narrower field of examination; specifically, microplegia, del Nido, Custodiol HTK, and 4:1 blood cardioplegia. Other combinations of cardioplegia, including St. Thomas’s Solution and the University of Wisconsin (UW) Solution, were considered when applicable according to the context of the publication being reviewed. Factors being assessed consisted of scientific validity, nature of the test subject (isolated organ vs. animal vs. human studies), experimental setup (retrospective trials vs. randomized clinical trials) and patient outcomes. Results: There are very few randomized clinical trials with human subjects comparing commonly used cardioplegic solutions. Numerous retrospective studies exist, but often show similar intraoperative and postoperative outcomes between the solutions. Some solutions, del Nido cardioplegia in particular, were found to have few or no significant human trials to back the rigor required in such a highly specialized field as cardiovascular surgery. A wide variation in the types of surgeries and primary outcomes were included in the publications, so it is difficult to perform an accurate systematic review of the topic. Conclusion: Uniform variables among different studies would be preferable for analysis of this topic; thus, it is the researchers’ recommendation that the collection of multicenter data be undertaken in order to more fully answer this research question. Comparative effectiveness studies to associate commonly used solutions are needed. Without this research, surgeon preference remains the primary determining factor for deciding which cardioplegic solution to use. Cardioplegia selection should rely more on higher scientific research, using evidenced-based medicine and ranking of clinical studies.
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Affiliation(s)
- ZG Ferguson
- Medical University of South Carolina, Charleston, USA
| | - DE Yarborough
- Medical University of South Carolina, Charleston, USA
| | - BL Jarvis
- Medical University of South Carolina, Charleston, USA
| | - JJ Sistino
- Medical University of South Carolina, Charleston, USA
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20
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Bojan M, Vouhe P. Reply: To PMID 23462260. Ann Thorac Surg 2014; 97:2234. [PMID: 24882330 DOI: 10.1016/j.athoracsur.2014.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 02/19/2014] [Accepted: 04/01/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Mirela Bojan
- Anesthesia and Critical Care, Necker-Enfants Malades University Hospital, Assistance Publique - Hopitaux de Paris, Paris, France.
| | - Pascal Vouhe
- Pediatric Cardiac Surgery, Necker-Enfants Malades University Hospital, Assistance Publique - Hopitaux de Paris, Paris Cedex 15, France; Paris Descartes University, Paris, France
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21
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Edelman JJB, Seco M, Dunne B, Matzelle SJ, Murphy M, Joshi P, Yan TD, Wilson MK, Bannon PG, Vallely MP, Passage J. Custodiol for myocardial protection and preservation: a systematic review. Ann Cardiothorac Surg 2014; 2:717-28. [PMID: 24349972 DOI: 10.3978/j.issn.2225-319x.2013.11.10] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/10/2013] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Custodiol cardioplegia is attractive for minimally invasive cardiac surgery, as a single dose provides a long period of myocardial protection. Despite widespread use in Europe, there is little data confirming its efficacy compared with conventional (blood or crystalloid) cardioplegia. There is similar enthusiasm for its use in organ preservation for transplant, but also a lack of data. This systematic review aimed to assess the evidence for the efficacy of Custodiol in myocardial protection and as a preservation solution in heart transplant. METHODS Electronic searches were performed of six databases from inception to October 2013. Reviewers independently identified studies that compared Custodiol with conventional cardioplegia (blood or extracellular crystalloid) in adult patients for meta-analysis; large case series that reported results using Custodiol were analyzed. Next, we identified studies that compared Custodiol with other organ preservation solutions for organ preservation in heart transplant. RESULTS Fourteen studies compared Custodiol with conventional cardioplegia for myocardial protection in adult cardiac surgery. No difference was identified in mortality; there was a trend for increased incidence of ventricular fibrillation in the Custodiol group that did not reach statistical significance. No difference was identified in studies that compared Custodiol with other solutions for heart transplant. CONCLUSIONS Despite widespread clinical use, the evidence supporting the superiority of Custodiol over other solutions for myocardial protection or organ preservation is limited. Large randomised trials are required.
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Affiliation(s)
- J James B Edelman
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia; ; The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michael Seco
- The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ben Dunne
- Department of Cardiothoracic Surgery, Royal Perth Hospital, Perth, Australia
| | - Shannon J Matzelle
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Michelle Murphy
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Pragnesh Joshi
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Tristan D Yan
- The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael K Wilson
- The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; ; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Paul G Bannon
- The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael P Vallely
- The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; ; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Jurgen Passage
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia; ; Notre Dame Medical School, Fremantle, Australia
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Nigro JJ, Velez DA. Retrograde Cardioplegia for Myocardial Protection During Arterial Switch Operation. Ann Thorac Surg 2014; 97:2233-4. [DOI: 10.1016/j.athoracsur.2013.10.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 10/08/2013] [Accepted: 10/18/2013] [Indexed: 10/25/2022]
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Bojan M, Pouard P. Reply: To PMID 24296215. Ann Thorac Surg 2014; 96:2287-8. [PMID: 24296217 DOI: 10.1016/j.athoracsur.2013.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 08/13/2013] [Accepted: 09/19/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Mirela Bojan
- Anesthesia and Critical Care, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris, 149, rue de Sèvres, Paris, France 75015.
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Bojan M, Pouard P. Reply: To PMID 23462260. Ann Thorac Surg 2014; 96:2286. [PMID: 24296216 DOI: 10.1016/j.athoracsur.2013.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 08/13/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Mirela Bojan
- Anesthesia and Critical Care, Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris, 149, rue de Sèvres, Paris, France 75015.
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Durandy Y, Rubatti M. Warm blood microplegia redosing interval in pediatric surgery. Ann Thorac Surg 2014; 96:2285-6. [PMID: 24296214 DOI: 10.1016/j.athoracsur.2013.06.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 05/18/2013] [Accepted: 06/11/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Yves Durandy
- Pediatric Cardiac Surgery, CCML 133 Avenue de la Resistance, 92350 Le Plessis Robinson, France.
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Lueck S, Angeli E. Challenge of Neonatal Myocardial Protection. Ann Thorac Surg 2013; 96:2286-7. [DOI: 10.1016/j.athoracsur.2013.05.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 04/12/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
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