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Del Nido versus Bretschneider cardioplegic solution in valve replacement for severe aortic stenosis – a case-control pilot study
INTRODUCTION: The adequate protection provided by the del Nido cardioplegia has already been proven in trials comparing the solution with blood cardioplegia. However, evidence regarding comparison to the Bretschneider HTK solution is limited. AIM: To determine the efficacy of the del Nido cardiopleg...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Termedia Publishing House
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9290408/ https://www.ncbi.nlm.nih.gov/pubmed/35891993 http://dx.doi.org/10.5114/kitp.2022.117496 |
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author | Sanetra, Krzysztof Domaradzki, Wojciech Białek, Krzysztof Shrestha, Rajesh Bochenek, Andrzej Jankowska-Sanetra, Justyna Buszman, Piotr P. Gerber, Witold |
author_facet | Sanetra, Krzysztof Domaradzki, Wojciech Białek, Krzysztof Shrestha, Rajesh Bochenek, Andrzej Jankowska-Sanetra, Justyna Buszman, Piotr P. Gerber, Witold |
author_sort | Sanetra, Krzysztof |
collection | PubMed |
description | INTRODUCTION: The adequate protection provided by the del Nido cardioplegia has already been proven in trials comparing the solution with blood cardioplegia. However, evidence regarding comparison to the Bretschneider HTK solution is limited. AIM: To determine the efficacy of the del Nido cardioplegia when compared to Bretschneider HTK solution in patients undergoing aortic valve replacement for severe aortic stenosis. MATERIAL AND METHODS: Ten patients undergoing isolated aortic valve replacement for severe aortic stenosis using the del Nido solution (group 1) were case-control matched to patients undergoing aortic valve replacement (AVR) using the Bretschneider solution (group 2). The observation included: cardioplegia dosage, time to cardiac arrest, cross-clamp and extracorporeal circulation time, ventricular fibrillation (VF) after removing the cross-clamp, gasometry parameters, creatinine kinase (MB isoenzyme – CK-MB) at 24 and 48 h following the surgery and troponin (highsensitivity troponin T – hsTnT) at 24 and 48 h. RESULTS: Patients were no different in terms of comorbidities. Higher incidence of VF occurred in group 2 (3 vs. 9, 30% vs. 90%; p = 0.02). Blood sodium measurements after removing the cross-clamp were significantly higher in group 1 (median 137.0 vs. 130.0; p = 0.0004). Biomarker release trended toward lower values in group 1, but not significantly (median troponin at 24 h: 223.1 pg/ml vs. 294.8 pg/ml; p = 0.4 and 48 h: 208.0 pg/ml vs. 242.5 pg/ml; p = 0.7, median CK-MB at 24 h: 16.6 ng/ml vs. 17.3 ng/ml; p = 0.6, and 48 h: 6.7 ng/ml vs. 5.08 ng/ml; p = 0.3). Peak creatinine trended towards lower values in group 2, but not significantly (1.35 mg/dl vs. 1.05 mg/dl; p = 0.09). CONCLUSIONS: Both del Nido and Bretschneider cardioplegia provide satisfactory myocardial protection. However, del Nido cardioplegia reduces the incidence of VF after declamping the aorta. Further studies are required. |
format | Online Article Text |
id | pubmed-9290408 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Termedia Publishing House |
record_format | MEDLINE/PubMed |
spelling | pubmed-92904082022-07-25 Del Nido versus Bretschneider cardioplegic solution in valve replacement for severe aortic stenosis – a case-control pilot study Sanetra, Krzysztof Domaradzki, Wojciech Białek, Krzysztof Shrestha, Rajesh Bochenek, Andrzej Jankowska-Sanetra, Justyna Buszman, Piotr P. Gerber, Witold Kardiochir Torakochirurgia Pol Original Paper INTRODUCTION: The adequate protection provided by the del Nido cardioplegia has already been proven in trials comparing the solution with blood cardioplegia. However, evidence regarding comparison to the Bretschneider HTK solution is limited. AIM: To determine the efficacy of the del Nido cardioplegia when compared to Bretschneider HTK solution in patients undergoing aortic valve replacement for severe aortic stenosis. MATERIAL AND METHODS: Ten patients undergoing isolated aortic valve replacement for severe aortic stenosis using the del Nido solution (group 1) were case-control matched to patients undergoing aortic valve replacement (AVR) using the Bretschneider solution (group 2). The observation included: cardioplegia dosage, time to cardiac arrest, cross-clamp and extracorporeal circulation time, ventricular fibrillation (VF) after removing the cross-clamp, gasometry parameters, creatinine kinase (MB isoenzyme – CK-MB) at 24 and 48 h following the surgery and troponin (highsensitivity troponin T – hsTnT) at 24 and 48 h. RESULTS: Patients were no different in terms of comorbidities. Higher incidence of VF occurred in group 2 (3 vs. 9, 30% vs. 90%; p = 0.02). Blood sodium measurements after removing the cross-clamp were significantly higher in group 1 (median 137.0 vs. 130.0; p = 0.0004). Biomarker release trended toward lower values in group 1, but not significantly (median troponin at 24 h: 223.1 pg/ml vs. 294.8 pg/ml; p = 0.4 and 48 h: 208.0 pg/ml vs. 242.5 pg/ml; p = 0.7, median CK-MB at 24 h: 16.6 ng/ml vs. 17.3 ng/ml; p = 0.6, and 48 h: 6.7 ng/ml vs. 5.08 ng/ml; p = 0.3). Peak creatinine trended towards lower values in group 2, but not significantly (1.35 mg/dl vs. 1.05 mg/dl; p = 0.09). CONCLUSIONS: Both del Nido and Bretschneider cardioplegia provide satisfactory myocardial protection. However, del Nido cardioplegia reduces the incidence of VF after declamping the aorta. Further studies are required. Termedia Publishing House 2022-06-29 2022-06 /pmc/articles/PMC9290408/ /pubmed/35891993 http://dx.doi.org/10.5114/kitp.2022.117496 Text en Copyright: © 2022 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska) https://creativecommons.org/licenses/by-nc-sa/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license. |
spellingShingle | Original Paper Sanetra, Krzysztof Domaradzki, Wojciech Białek, Krzysztof Shrestha, Rajesh Bochenek, Andrzej Jankowska-Sanetra, Justyna Buszman, Piotr P. Gerber, Witold Del Nido versus Bretschneider cardioplegic solution in valve replacement for severe aortic stenosis – a case-control pilot study |
title | Del Nido versus Bretschneider cardioplegic solution in valve replacement for severe aortic stenosis – a case-control pilot study |
title_full | Del Nido versus Bretschneider cardioplegic solution in valve replacement for severe aortic stenosis – a case-control pilot study |
title_fullStr | Del Nido versus Bretschneider cardioplegic solution in valve replacement for severe aortic stenosis – a case-control pilot study |
title_full_unstemmed | Del Nido versus Bretschneider cardioplegic solution in valve replacement for severe aortic stenosis – a case-control pilot study |
title_short | Del Nido versus Bretschneider cardioplegic solution in valve replacement for severe aortic stenosis – a case-control pilot study |
title_sort | del nido versus bretschneider cardioplegic solution in valve replacement for severe aortic stenosis – a case-control pilot study |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9290408/ https://www.ncbi.nlm.nih.gov/pubmed/35891993 http://dx.doi.org/10.5114/kitp.2022.117496 |
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