Comparison between the effects of bretschneiders htk solution and cold blood cardioplegia on systemic endothelial functions in patients who undergo coronary artery bypass surgery: a prospective randomized and controlled trial

Abstract Objective: To investigate the effects of Bretschneider's histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegia on systemic endothelial functions. Methods: A total of 50 patients who underwent isolated coronary artery bypass surgery between March 2018 and May 2018 were randomly divided into two groups - group 1 (Bretschneider's HTK solution, n=25) and group 2 (cold blood cardioplegia, n=25). Data related to the indicators of endothelial dysfunction were recorded. Flow-mediated dilation was measured together with the assessment of the values of endothelin-1, von Willebrand factor, and asymmetric dimethylarginine to identify endothelial dysfunction. Then, the two groups were compared regarding these values. Results: The most significant result of our study was that the endothelin-1 level was significantly higher in group 2 than in group 1 (P<0.001). The value of flow-mediated dilation was found to increase to a lesser degree on the postoperative days compared to the value at the day of admission in group 1 (P=0.002 and P=0.030, respectively). Conclusion: Cardiopulmonary bypass leads to endothelial dysfunction. Our results revealed that Bretschneider's HTK solution causes less severe endothelial injury than cold blood cardioplegia.

Glucose-Insulin-Potassium Solution Protects Ventricular Myocytes of Neonatal Rat in an In Vitro Coverslip Ischemia/Reperfusion Model

BACKGROUND AND OBJECTIVES: The benefit of high glucose-insulin-potassium (GIK) solution in clinical applications is controversial. We established a neonatal rat ventricular myocyte (NRVM) in vitro coverslip ischemia/reperfusion (I/R) model and investigated the effects of GIK solution on suppressing reactive oxygen species (ROS) and upregulating O-GlcNacylation, which protects cells from ischemic injury. MATERIALS AND METHODS: NRVMs were isolated from postnatal day 3-4 Sprague-Dawley rat pups and grown in Dulbecco's modified Eagle's medium containing high glucose (4.5 g/L), fetal bovine serum, and penicillin/streptomycin. The effects of the GIK solution on ROS production, apoptosis, and expression of O-GlcNAc and O-GlcNAc transferase (OGT) were investigated in the coverslip I/R model. RESULTS: Covering the 24-well culture plates for 3 hr with 12 mm diameter coverslips resulted in the appropriate ischemic shock. Glucose and insulin synergistically reduced ROS production, protected NRVM dose-dependently from apoptosis, and altered O-GlcNAc and OGT expression. CONCLUSION: The high GIK solution protected NRVM from I/R injury in vitro by reducing ROS and altering O-GlcNacylation.

The influence of different types of cardioplegic solutions on homeostasis during open heart surgery / Монголын Анагаах Ухаан

BackgroundOpen cardiac surgery in CPB condition has increased dramatically in the recent 5 years. Therefore,multidisciplinary researches are needed on this new technological method. The surgical results andperioperative complications depends on keeping normal level of homeostasis parameters during CPBin the open heart surgery.Materials and MethodsTo study the influence of blood cardioplegic and Del Nido’s solution on homeostasis duringcardiopulmonary bypass, we concluded retrospective sample survey using CPB reports from 535 patients,who underwent cardiac surgery with CPB between 2008 and 2012, in 3rd Hospital’s cardiovascularsurgery department.We calculated average parameters of homeostasis, and studied an aortic cross clamp, CPB time,hemodilution and heart recovery process, on three stages of the surgery.We did comparative study on 21 cases of children, who went under congenital heart disease surgery;using Del Nido’s and blood cardioplegic solution.ResultIn recent 5 years, artery blood indicators were pH=7.45±0.06, paCO2=28.8±5.86 mm.Hg,paO2=398.3±99.33 mm.Hg, BE=-4.15±2.51 mmol/l, HCO¯3=20.57±2.18 mmol/l, Ht=28.15±5%,K+=4.12±0.87 mmol/l and Na+=140±3.22 mmol/l during open cardiac surgery in CPB condition(n=535).In case group (n=21), these indicators were pH=7.33±0.09, paCO2=37.49±12.11 mm.Hg,paO2=465.76±77.54 mm.Hg, BE=-6.2±2.78 mmol/l, HCO¯3=20.44±2.46 mmol/l, Ht=27.38±5.12%,K+=3.65±0.46 mmol/l and Na+=141.22±2.64 mmol/l. In control group (n=21), above results werepH=7.40±0.07, paCO2=28.52±6.34 mm.Hg, paO2=394±88.92 mm.Hg, BE=-5.52±2.37 mmol/l,HCO¯3=18.84±2.39 mmol/l, Ht=27.66±3.52%, K+=3.86±0.66 mmol/l and Na+=141.2±3.22 mmol/l.Conclusions:1. When acid and alkaline balance was normal during CPB, hyperoxia and hypocapnia are appearedthrough gas analysis (p=0.0001). Metabolic acidity and hyperoxia showed up in the case group, whohad used Del Nido’s solution (p=0.0001).2. As the beginning of CPB, patient’s hematocrit is reduced by 10.26% (p=0.0001). The influences ofboth Del-Nido and blood cardioplegic solutions are the same on hemodilutes (p=0.26).3. While blood cardioplegic solution is used, heart is refreshed with 80.3% sinusial rhythm(p=0.0001).4. Aortic cross clamp time and increases repetition of cardioplegic solutions are correlated with cardiacrecovery time positively (r=0.445, p=0.0001, n=520).

The homeostasis during cardiopulmonary bypass / Монголын Анагаах Ухаан

BackgroundOpen cardiac surgery in CPB condition has increased dramatically in the recent 5 years. Therefore,multidisciplinary researches are needed on this new technological method. The surgical results andperioperative complications depends on keeping normal level of homeostasis parameters during CPBin the open heart surgery.Materials and MethodsTo study the parameters of homeostasis during cardiopulmonary bypass, we concluded retrospectivesample survey using CPB reports from 535 patients, who underwent cardiac surgery with CPB between2008 and 2012, in 3rd Hospital’s cardiovascular surgery department.We calculated average parameters of homeostasis, and studied heart recovery process.ResultIn recent 5 years, artery blood indicators were pH=7.45±0.06, paCO2=28.8±5.86 mm.Hg,paO2=398.3±99.33 mm.Hg, BE=-4.15±2.51 mmol/l, HCO¯3=20.57±2.18 mmol/l, Ht=28.15±5%,K+=4.12±0.87 mmol/l and Na+=140±3.22 mmol/l during open cardiac surgery in CPB condition(n=535).80.3% of patients’ heart spontaneously recovered and stabilized with sinus rhythm. 16.4% of them wererecovered with fibrillation while 2.1% of them were recovered with adrenomimetic support and 1.2% ofthem were recovered with strong adrenomimetic support and defibrillation.Conclusions:1. When acid and alkaline balance was normal during CPB, hyperoxia and hypocapnia are appearedthrough gas analysis (p=0.0001).2. While blood cardioplegic solution is used, heart is refreshed with 80.3% sinusial rhythm(p=0.0001).

The effects of ulinastatin-containing autologous cold blood cardioplegic solution on the cardiac function of infants after open heart surgery / 中国综合临床

Objective To investigate the effects of ulinastatin-containing autologous cold blood cardioplegic solution on the cardiac function of infants after cardiopulmonary bypass surgery.Methods Sixty infants younger than 10 months old,who underwent ventricular septal defect repair under cardiopulmonary bypass,were randomized into autologous cold blood cardioplegia group (30 patients,Group A)and ulinastatincontaining cold blood cardioplegia group (30 patients,Group B).CI,SI and LCWI were monitored 1 and 6 hours after opening the aorta.The time and rate of cardiac resuscitation,as well as the dependence on the inotropic drugs,were intraoperatively monitored.Results The automatic resuscitation rate in two groups was not siynificantly ( P ＞ 0.05).The time for automatic resuscitation were (34.2 ± 4.7) s and (52.1 ± 6.5 ) s for Group B and Group A,respectively ( P ＜ 0.05 ).The rate of dependence on inotropic drug were 40.0％ (12/30) and 66.7％ (20/30)for Group B and Gro~p A,respectively (P ＜ 0.05).Mter the operation,the CI,SI and LCWI of group B were higher than that of group A ( P ＜0.05 ).Conclusion Ulinastatin-containing autologous cold blood cardioplegic solution is beneficial to the functional cardiac recovery of the infants after heart bypass surgery by protecting the immature myocardium.

Myocardial Protective Effect of Histidine-Tryptophan-Ketoglutarate Solution and Cold Blood Cardioplegic Solution in Pediatric Cardiac Surgery / 영남의대학술지

BACKGROUND: There is limited data on comparisons between the effect of histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegic (CBC) solution in pediatric cardiac surgery. The purpose of this study was to compare the myocardial protective effect of HTK solution and CBC solution in patients undergoing pediatric cardiac surgery. MATERILAS AND METHODS: We selected 49 patients with ventricular septal defect and atrial septal defect. HTK solution was used in 21 patients and CBC solution was used in 28 patents. HTK solution was given as a single dose, whereas CBC solution was used in the usual multi-dose method. The incidence of EKG change and concentration of Troponin T and CK-MB were compared for the evaluation of myocardial damage. RESULTS: There were no significant differences in the incidence of ST, T segment change by EKG and serial cardiac enzyme levels between two groups. CONCLUSION: These results suggested that the myocardial protective effect of HTK solution was similar to CBC solution in simple pediatric cardiac surgery.

Comparison of Cardioprotection between Histidine-Tryptophan-Ketoglutarate Cardioplegia and DelNido Cardioplegia in Isolated Rat Hearts / 대한흉부외과학회지

BACKGROUND: The aim of this study is to define the cardioprotective effects (hemodynamic, cytochemical and ultrastructural of the newly developed Histidine-Tryptophan-Ketoglutarate (HTK) cardioplegia compared to DelNido cardioplegia. MATERIAL AND METHOD: Seventy-nine isolated rat hearts were divided into three groups on the basis of techniques of cardioplegia infusion. Twenty-eight hearts (Group 1) were flushed with cold DelNido cardioplegia with every 40 minutes for 2 hours. Twenty-seven hearts (Group 2) were flushed with cold HTK cardioplegia for once during the 2 hours. Twenty-four hearts (Group 3) were flushed with cold HTK cardioplegia with every 40 minutes for 2 hours. Heart rate, left ventricular developed pressure (LVDP), changes of +dp/dt max, coronary flow, and rate-pressure product value were measured at pre-ischemic, post-reperfusion 15 minutes, 30 minutes, and 45 minutes for hemodynamic study. Aspartate aminotransferase (AST), lactate dehydrogenase (LD), creatine kinase (CK), CK- MB, troponin-I, myoglobin, and lactate were measured at pre-ischemic and post-reperfusion 45 minutes for cytochemical parameters. Mitochondrial scores were counted in 3 cases from each group for ultrastructural assessment. RESULT: In hemodynamic study, there were no significant differences among group 1, group 2, and group 3. However, the decrease values of heart rate in group 2 and 3 exhibited significantly lower values than in group 1. In cytochemical study, there were no significant differences among group 1, group 2, and group 3. However, the increase values of lactate in group 2 and 3 exhibited significantly lower values than in group 1. In ultrastructural assessment, the mean myocardial mitochondria scores in group 1, group 2, and group 3 were 2.14+/-0.10, 1.52+/-0.57, and 2.10+/-0.16. CONCLUSION: HTK solution provides adequate myocardial protection with some advantages over DelNido solution in isolated rat hearts.

Comparison of cold blood and cold crystalloid cardioplegia on myocardial protection effects in valve replacement surgery / 中国医师杂志

Objective To compare the myocardial protection effects of cold blood cardioplegia and cold crystalloid cardioplegia in patients undergoing valve replacement surgery.Methods One hundred adult patients with cardiac function Ⅱ～Ⅲ class undergoing primary elective valve replacement surgery due to rheumatic heart disease were retrospectively analyzed.For patients with cardiac arrest,cold blood cardioplegia was applied to 50 cases(Group B),and cold crystalloid cardioplegia to the others(group C).The process of heart resuscitation,the postoperative need of dopamine,the blood pressure and heart rate,the postoperative level of serum myocardial enzyme,the intensive care unit(ICU) stay after operation were collected and statistically analyzed.All the cardioplegic solution was perfused in a similar manner and topical cooling was employed simultaneously.Results There were less cases in group B than in group C who needed isoprenaline for cardiac resuscitation after clamp removal(P0.05).Conclusion The cold blood cardioplegia and cold crystalloid cardioplegia have similar myocardial protection effects on rheumatic heart disease patients with cardiac function Ⅱ～Ⅲ class undergoing valve replacement surgery.

The Clinical Analysis of the Intermittent Warm Blood Cardioplegia by Admixing Potassium Only / 대한흉부외과학회지

BACKGROUND: Since the introduction of warm blood cardioplegic myocardial protection, the results of numerous clinical trials have been reported. However , the increased reliance oncrystalloid cardioplegia with longer cross clamp time, the controversies surrounding the issue of right ventricular protection with retrograde cardioplegia, and problems of securing a good operative field of vision have all been pointed out as unresolved. To overcome these shortcomings, Antonio et al, in 1995 published the use of intermittent warm blood cardioplegia by admixing potassium only with good clinical results. The obj ectives of the current investigation were to assess the effects and applicability of warm blood cardioplegia with potassium only. MATERIAL AND METHOD: From May of 1998 to January of 1999, the results of coronary surgery or open heart surgery in 70 patients under intermittent warm blood potassium only cardioplegia were compared with the results of 70 case matched patients undergoing similar operations with intermittent cold blood cardioplegia. RESULT: The amount of cardioplegic solution required during cardiopulmonary bypass(1463+/-68.0 min, 3584+/-179 min, p<0.001), the time to recovery of consciousness postoperatively(3.5+/-0.4 min, 4.9+/-0.8 min, p=0.044), intubation duration(10.8+/-0.8 hr , 13.2+/-0.6 hr , p=0.017), and the inci-dence of rrhythmia requiring the use of lidocaine(75.2+/-6.8 mg, 114.5+/-7.2 mg, p=0.006), which were found to be less in the warm potassium only group were statistically significant. However, the differences in postoperative cardiac enzymne elevation and postoperative mortality and morbidity were statistically insignificant. CONCLUSION: The current study showed warm intermittent potassium only blood cardioplegia to be at least equally effective as cold intermittent blood cardioplegia in providing myocardial protection. Furthermore, the reduction in cardiopulmonary bypass, mental recovery and intubation times strongly support the use of this method for intraopertaive myocardial protection.

Protective effect of warm blood cardioplegia on ischemic rabbit myocardium / 中国临床药理学与治疗学

0.05 ). GLDH was significantly higher (P 0.05 ). The value of CK MB was significantly lower (P 0.05 ). Myocardium water content in group Ⅰ was the lowest among the three groups (P 0.05 ). Myocardial ultrastructure study showed that group Ⅰ was better protected than the other two groups, and group Ⅱ better than group Ⅲ. Stereological quantitative analysis determined by calculation of mitochondria area density revealed significant differences between the three groups, in which group Ⅰ was lower than group Ⅱ (P

Myocardial protective effects of continuous infusion with normothermic oxygenated crystalloid solution or blood cardioplegia during normothermic cardtopulmonary bypass / 中华麻醉学杂志

The myocardial protective effect of continuous infusion with normothermic oxygenated crystalloid solution or blood cardioplegia during normothermic CPB was studied in 15 dogs. Ultrastructure. levels of adenine nucleotides,lipid peroxide (LPO),water content of heart musle,hemodynamics were observed. Dogs were randomly divided into three groups. Group Ⅰ: intermittent infusion with cold crystsalloid cardioplegia during hypothermic CPB (n=5); Group Ⅱ: continuous infusion with normothermic oxygenated blood cardioplegia during normothermic CPB(n=5); Group Ⅲ: continuous infusion with normothermic oxygenatde crystalloid cardioplegia duriug normothermic CPB((n=5). The normal mitochandria contents and glycogen stores in group Ⅱ and Ⅲ were significantly higher than those in group Ⅰ(P

Protective effects of cardioplegic solution containing Shenfu injectio on isolated rabbit heart against ischemia-reperfusion injury / 中华麻醉学杂志

Objective To investigate the protective effects of cardioplegic solution containing different concentrations of Shenfu injectio on isolated rabbit heart against ischemia-reperfusion(I/R)injury.Methods Forty adult long-ear white rabbits weighing 3.8-4.2 kg were anesthetized with intraperitoneal thiopental 40 mg?kg~(-1).Heparin 4 mg?kg~(-1) was injected Ⅳ.Hearts were immediately removed and mounted on a Langendorff apparatus and perfused via aorta with Krebs-Henseleit solution aerated at 37℃ with 95 % O_2 and 5 % CO_2.Forty isolated hearts were randomly divided into 5 groups(n=8 each):control group in which cardiac arrest was induced with St Thomas hyperkkaelemic cardioplegic solution and 4 Shenfu groups(SF)in which cardiac arrest was induced with St Thomas cardioplegic solution containing different concentrations of Shenfu injectio:1%(SF1), 5%(SF5),10%(SF10)and 15%(SF15).All hearts in the 5 groups were subjected to global ischemia for 45 min followed by 40 min reperfusion.Coronary effluent was collected after reperfusion for determination of CK-MB activity.Mitochondria were isolated arid Ca~(2+) and MDA content was measured.Myocardial ultrastructure was observed using electron microscope.Mitochondrial injury was assessed by using Flameng score and stereology(NA and ?).Results The CK-MB activity in coronary effluent,mitochondrial MDA and Ca~(2+) content and Flameng score were decreased and NA was increased in group SF1,SF5 and SF10 as compared with control group(P＜ 0.05 or 0.01).The ? of mitochondria was increased in group SF5 and SF10 as compared with control group(P＜ 0.01).The CK-MB activity and Ca~(2+) content were increased and MDA content was decreased in group SF15 as compared with control group(P＜0.05).The pathological damage to myocardium was significantly less in group SF5 and SF10 than in control group.Conclusion Shenfu injectio added to St Thomas cardioplegic solution at concentration of 5%～10% can protect myocardial mitochondria against I/R injury.

Relationship between ?_1-aderenergic receptor and cardiac function in hypoxic newborn guinea-pig myocardia subjected to ischemic reperfusion / 第三军医大学学报

Objective To study the relationship between ? 1-aderenergic receptor (? 1-AR) and cardiac function in hypoxic newborn guinea-pig myocardia undergoing ischemic reperfusion, and the effects of St. Thomas Hospital cardioplegic solution Ⅱ (STS) and cold blood cardioplegia (CBC) on the ? 1-AR and cardiac function. Methods Normobaric hypoxic guenia-pig model and isolated perfused working heart preparation were established. Cardiac functions were recorded by a multichannel biologic signal analyzer. Myocardial ? 1-AR density (B max ) and affinity (K d) were investigated by radial ligand binding. Results Significant decrease of B max was found in hypoxic newborn guinea-pig myocardia suffering from hypothermic (20 ℃)-ishemic reperfusion (P0.05). Conclusion The impairment of cardiac function in hypoxic newborn guinea-pig undergoing myocardial ischemic reperfusion might be associated with the decline of B max , but not with K d. Different effects of STS and CBC on cardiac function may result from their different influences on B max .

MYOCARDUAL PROTECTION——THE ENZYMATIC CHANGES OF THE RIGHT ATRIAL WALL DURING CARDIOPLEGIC ARREST / 西安交通大学学报(医学版)

The authors studied the changes of myocardial enzymes (CPK, CPK-MB, LDH) in the wall of the right atrium during cardioplegic arrest in ninsecutive patients who had an open heart operation, observed the changes of these enzymes in seium as well The results indicate that when the crystalloid cardioplegic solution, systemic moderate hypothermia and decp local hypothermia are used to protect the myocardium, the right atrium can get satisfactory protection during cardioplegic arrest and there is no statistical differences of enzyme changes between samples taken from the right atrium before and after the arrest. The article still discussed the possibility of using the changes of atrial myocardial enzymes as an index to reflect the extent of myocardial protion. The authors consider that the change of myocardial enzyme can better reflect the metabolic activity of myocardium during cardioplegic arrest.