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Tunca NU, Yesilkaya NK, Karaagac E, Durmaz H, Besir Y, Gokalp O, Iner H, Yılık L, Gurbuz A. Comparison of Bretschneider HTK cardioplegia solution and blood cardioplegia in terms of postoperative results in patients who underwent isolated supracoronary ascending aortic replacement. Perfusion 2024; 39:1205-1212. [PMID: 37290096 DOI: 10.1177/02676591231182587] [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] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Cardiac arrest with cardioplegia is the most common and reliable method of myocardial protection in cardiac surgery, but there is no definite consensus on the use of different types of cardioplegia. Two of the commonly used types of cardioplegia are Bretschneider histidine-tryptophan-ketoglutarate solution (Custodiol) and conventional blood cardioplegia. In this study, Custodiol solution and conventional blood cardioplegia used in patients with type A aortic dissection who underwent supracoronary ascending aortic replacement were aimed to be compared in terms of postoperative results. METHODS 70 patients with type A aortic dissection who underwent supracoronary ascending aortic replacement in our clinic between January 2011 - October 2020 were included. Patients were divided into two groups, blood cardioplegia group (n = 48) and Custodiol group (n = 22) and they were compared regarding preoperative, perioperative and postoperative variables. RESULTS There was no significant difference between cardiopulmonary bypass time and cross-clamp time (p = 0.17 and p = 0.16, respectively). Mechanical ventilator weaning time, intensive care unit stay and hospital stay were shorter in Custodiol group (p = 0.04,p = 0.03 and p = 0.05, respectively). While inotropic support need was higher in the blood cardioplegia group (p = 0.001), there was no significant difference in terms of mortality, arrhythmia, neurological complications and renal complications. CONCLUSIONS Our results show that Custodiol cardioplegia solution may be superior to blood cardioplegia in reducing mechanical ventilation weaning period, intensive care and hospital stay, and reducing the use of inotropic agents in patients with type A aortic dissection undergoing supracoronary ascending aorta replacement.
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Affiliation(s)
- Nuri Utkan Tunca
- Department of Cardiovascular Surgery, Mus State Hospital, Mus, Turkey
| | - Nihan Karakas Yesilkaya
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Erturk Karaagac
- Department of Cardiovascular Surgery, Mus State Hospital, Mus, Turkey
| | - Huseyin Durmaz
- Department of Cardiovascular Surgery, Konya City Hospital, Konya, Turkey
| | - Yuksel Besir
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Orhan Gokalp
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Hasan Iner
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Levent Yılık
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Ali Gurbuz
- Department of Cardiovascular Surgery, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
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Monaco F, Labanca R, Fresilli S, Barucco G, Licheri M, Frau G, Osenberg P, Belletti A. Effect of Urine Output on the Predictive Precision of NephroCheck in On-Pump Cardiac Surgery With Crystalloid Cardioplegia: Insights from the PrevAKI Study. J Cardiothorac Vasc Anesth 2024; 38:1689-1698. [PMID: 38862287 DOI: 10.1053/j.jvca.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES Previous studies in other settings suggested that urine output (UO) might affect NephroCheck predictive value. We investigated the correlation between NephroCheck and UO in cardiac surgery patients. DESIGN Post hoc analysis of a multicenter study. SETTING University hospital. PARTICIPANTS Patients who underwent cardiac surgery using cardiopulmonary bypass (CPB) and crystalloid cardioplegia. MEASUREMENTS AND MAIN RESULTS All patients underwent NephroCheck testing 4 hours after CPB discontinuation. The primary outcome was the correlation between UO, NephroCheck results, and acute kidney injury (AKI, defined according to Kidney Disease: Improving Global Outcomes). Of 354 patients, 337 were included. Median NephroCheck values were 0.06 (ng/mL)2/1,000) for the overall population and 0.15 (ng/mL)2/1,000) for patients with moderate to severe AKI. NephroCheck showed a significant inverse correlation with UO (ρ = -0.17; p = 0.002) at the time of measurement. The area under the receiver characteristic curve (AUROC) for NephroCheck was 0.60 (95% confidence interval [CI], 0.54-0.65), whereas for serum creatinine was 0.82 (95% CI, 0.78-0.86; p < 0.001). When limiting the analysis to the prediction of moderate to severe AKI, NephroCheck had a AUROC of 0.82 (95% CI, 0.77 to 0.86; p<0.0001), while creatinine an AUROC of 0.83 (95% CI, 0.79-0.87; p = 0.001). CONCLUSIONS NephroCheck measured 4 hours after the discontinuation from the CPB predicts moderate to severe AKI. However, a lower threshold may be necessary in patients undergoing cardiac surgery with CPB. Creatinine measured at the same time of the test remains a reliable marker of subsequent development of renal failure.
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Affiliation(s)
- Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy..
| | - Rosa Labanca
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Fresilli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaia Barucco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Licheri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna Frau
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paul Osenberg
- Department of Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Kang J, Hoyer A, Dieterlen MT, Oetzel H, Otto W, Ginther A, Pfannmüller B, Misfeld M, Noack T, Kiefer P, Borger MA. Comparison of modified Del Nido and Custodiol® cardioplegia in minimally invasive mitral valve surgery. Eur J Cardiothorac Surg 2024; 65:ezae161. [PMID: 38627243 DOI: 10.1093/ejcts/ezae161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/20/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVES In this study, we evaluated if modified Del Nido cardioplegia delivers comparable cardiac protection in comparison to Custodiol® in patients undergoing isolated minimally invasive mitral valve repair. METHODS From January 2018 to October 2021, all patients undergoing non-emergent isolated minimally invasive mitral valve repair were included in this study. The cardioplegia was chosen at the surgeons' discretion. The primary end points of this study were peak postoperative cardiac enzyme levels. Secondary end points were in-hospital mortality, hospital stay, occurrence of cardiac arrhythmias, pacemaker implantations, postoperative lactate and sodium levels and postoperative incidence of renal failure requiring dialysis. RESULTS A total of 355 patients were included in this study. The mean age of patients was 57. After propensity score matching, a total of 156 pairs were identified. There was no difference in cross-clamp time between both groups. Postoperative creatine kinase levels were higher in patients receiving Custodiol on the 1st and 2nd postoperative days. Creatine kinase isoenzyme MB levels were higher in patients receiving Custodiol on the 2nd postoperative day (0.5 ± 0.2 vs 0.4 ± 0.1 µmol/l s; P < 0.001). Postoperative Troponin T concentrations were similar between both groups. Maximum lactate concentrations were higher in patients receiving Custodiol on the day of surgery (2.4 ± 1.9 vs 2.0 ± 1.1 mmol/l; P = 0.04). The overall hospital stay was longer in patients receiving Del Nido cardioplegia (10.6 ± 3.2 vs 8 ± 4.1 days; P < 0.01). CONCLUSIONS Modified Del Nido cardioplegia based on Ionosteril® solution offers equivalent protection compared to Custodiol for isolated minimally invasive mitral valve repair.
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Affiliation(s)
- Jagdip Kang
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Alexandro Hoyer
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | - Hanna Oetzel
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Wolfgang Otto
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - André Ginther
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Bettina Pfannmüller
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Martin Misfeld
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, NSW, Australia
| | - Thilo Noack
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Philipp Kiefer
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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Barbero C, Pocar M, Marchetto G, Cura Stura E, Calia C, Dalbesio B, Filippini C, Salizzoni S, Boffini M, Rinaldi M, Ricci D. Single-Dose St. Thomas Versus Custodiol® Cardioplegia for Right Mini-thoracotomy Mitral Valve Surgery. J Cardiovasc Transl Res 2023; 16:192-198. [PMID: 35939196 PMCID: PMC9944000 DOI: 10.1007/s12265-022-10296-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/23/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Custodiol® and St. Thomas cardioplegia are widely employed in mini-thoracotomy mitral valve (MV) operations. One-dose of the former provides 3 h of myocardial protection. Conversely, St. Thomas solution is usually reinfused every 30 min and safety of single delivery is unknown. We aimed to compare single-shot St. Thomas versus Custodiol® cardioplegia. METHODS Primary endpoint of the prospective observational study was cardiac troponin T level at different post-operative time-points. Propensity-weighted treatment served to adjust for confounding factors. RESULTS Thirty-nine patients receiving St. Thomas were compared with 25 patients receiving Custodiol® cardioplegia; cross-clamping always exceeded 45 min. No differences were found in postoperative markers of myocardial injury. Ventricular fibrillation at the resumption of electric activity was more frequent following Custodiol® cardioplegia (P = .01). CONCLUSION Effective myocardial protection exceeding 1 h of ischemic arrest can be achieved with a single-dose St. Thomas cardioplegia in selected patients undergoing right mini-thoracotomy MV surgery.
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Affiliation(s)
- Cristina Barbero
- Cardiovascular and Thoracic Department, Division of Cardiac Surgery, , Città Della Salute E Della Scienza", University of Turin, Corso Dogliotti, 14, Turin, Italy.
| | - Marco Pocar
- Cardiovascular and Thoracic Department, Division of Cardiac Surgery, , Città Della Salute E Della Scienza”, University of Turin, Corso Dogliotti, 14 Turin, Italy ,Department of Surgical Sciences, University of Turin, Turin, Italy ,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanni Marchetto
- Cardiovascular and Thoracic Department, Division of Cardiac Surgery, , Città Della Salute E Della Scienza”, University of Turin, Corso Dogliotti, 14 Turin, Italy
| | - Erik Cura Stura
- Cardiovascular and Thoracic Department, Division of Cardiac Surgery, , Città Della Salute E Della Scienza”, University of Turin, Corso Dogliotti, 14 Turin, Italy
| | - Claudia Calia
- Cardiovascular and Thoracic Department, Division of Cardiac Surgery, , Città Della Salute E Della Scienza”, University of Turin, Corso Dogliotti, 14 Turin, Italy ,Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Bianca Dalbesio
- Cardiovascular and Thoracic Department, Division of Cardiac Surgery, , Città Della Salute E Della Scienza”, University of Turin, Corso Dogliotti, 14 Turin, Italy
| | | | - Stefano Salizzoni
- Cardiovascular and Thoracic Department, Division of Cardiac Surgery, , Città Della Salute E Della Scienza”, University of Turin, Corso Dogliotti, 14 Turin, Italy ,Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Massimo Boffini
- Cardiovascular and Thoracic Department, Division of Cardiac Surgery, , Città Della Salute E Della Scienza”, University of Turin, Corso Dogliotti, 14 Turin, Italy ,Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Cardiovascular and Thoracic Department, Division of Cardiac Surgery, , Città Della Salute E Della Scienza”, University of Turin, Corso Dogliotti, 14 Turin, Italy ,Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Davide Ricci
- Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genoa, Italy
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Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia. J Cardiovasc Dev Dis 2022; 9:jcdd9060178. [PMID: 35735807 PMCID: PMC9225441 DOI: 10.3390/jcdd9060178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/01/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023] Open
Abstract
The race for an ideal cardioplegic solution has remained enthusiastic since the beginning of the modern cardiac surgery era. The Bretschneider solution, belonging to the “intracellular cardioplegic” group, is safe and practical in myocardial protection during ischemic time. Over time, some particular concerns have arisen regarding the effects on cardiac metabolism and postoperative myocardial functioning. This paper reviews the most important standpoints in terms of theoretical and practical analyses.
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de Haan M, van Straten A, Overdevest E, de Jong M, Soliman-Hamad M. Safety of Custodiol cardioplegia: a cohort study in patients undergoing cardiac surgery with elongated aortic cross-clamp time. Perfusion 2020; 35:591-597. [PMID: 31948381 DOI: 10.1177/0267659119897239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/OBJECTIVES The increasing complexity of patients undergoing cardiac surgery requires extended myocardial ischaemic periods. Cardiac surgeons demand a cardioplegic solution with prolonged myocardial protection. Therefore, we introduced Custodiol in our centre in 2011. The aim of this study was to investigate the safety and efficacy of Custodiol compared with the standard method of cardioplegia. METHODS Between 2011 and 2016, 188 adult patients who underwent mitral valve surgery combined with coronary artery bypass grafting were included in this retrospective study. In 113 patients, Custodiol cardioplegia was used to achieve cardiac arrest, while St. Thomas Hospital solution was used in 75 patients. The primary endpoint of the study was the degree myocardial damage which was estimated by the measurement of creatine kinase-myocardial band on the first postoperative day. A linear regression analysis was performed to compare the aortic cross-clamp time with the postoperative myocardial damage in both groups. RESULTS The extracorporeal circulation time and aortic cross-clamp were significantly longer in the Custodiol group than in the St. Thomas group: 125.6 ± 32.5 minutes versus 93.1 ± 27.7 minutes (p < 0.001), respectively. However, there was no significant difference between the two groups regarding the postoperative levels of creatine kinase-myocardial band (96 (70-140) U/L vs. 86 (69-120) U/L, respectively; p = 0.321). There was no significant differences between the two groups regarding the 30-day mortality (6.1% vs. 5.5%, respectively; p = 1.000) or 120-day mortality (9.6% vs. 11.0%, respectively; p = 0.806). CONCLUSION Our findings demonstrate that Custodiol is a safe method of myocardial protection for patients who underwent mitral valve surgery with coronary artery bypass grafting in our hospital. Further investigations extended to more cardiac surgery populations are needed to confirm clinical benefits of Custodiol cardioplegia.
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Affiliation(s)
- Maarten de Haan
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Albert van Straten
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Ed Overdevest
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Michel de Jong
- Department of Cardiothoracic Surgery, UMC Utrecht, Utrecht, The Netherlands
| | - Mohamed Soliman-Hamad
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
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Gatti G, Fiore A, Zilio C, Michelotti S, Ecarnot F, Taffarello P, Perniciaro V, Priolo L, Castaldi G, Currò P, Benussi B, Pappalardo A, Chocron S, Folliguet T, Perrotti A. Bilateral Internal Thoracic Artery Grafting Concomitant With Other Cardiac Operations ― Insights From a European Multicenter Retrospective Study on 1,123 Consecutive Patients ―. Circ J 2019; 83:2466-2478. [DOI: 10.1253/circj.cj-19-0696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Giuseppe Gatti
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Antonio Fiore
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor
| | - Chiara Zilio
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Sara Michelotti
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Fiona Ecarnot
- Department of Thoracic and Cardiovascular Surgery, University Hospital Jean-Minjoz
| | | | - Vera Perniciaro
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Luigi Priolo
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Gianluca Castaldi
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Placido Currò
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Bernardo Benussi
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | | | - Sidney Chocron
- Department of Thoracic and Cardiovascular Surgery, University Hospital Jean-Minjoz
| | - Thierry Folliguet
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University Hospital Jean-Minjoz
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