Abstract
Both Delnido and HTK Cardioplegia provides excellent myocardial protection and reduces the frequency of cardioplegia administration which allows uninterrupted operation and also reduces ‘x’-clamp timing. Both helps smooth myocardial recovery with post operative minimal inotropic support. But in aortic valve replacement in severe aortic stenosis with hypertrophied myocardium delnido cardioplegia provides poor protection where HTK provides better.
Material and Methods: Twenty adult patients devided into two groups, Group-A (n=10) received delnido cardioplegia and Group-B (n=10) received HTK cardioplegia, underwent aortic valve replacement in severe aortic stenosis with hypertrophid myocardium. In both group same dose of cardioplegia (20ml/kg) was administered through anterograde route.
Results: In group –B after valve replacement cardiac function was satisfactory with good ejection fraction, no rhythm disturbances occurred, and hemodynamics was well maintained with minimum inotropic support where in group-A in 40%cases VT/VF, in 20% case low cardiac output, 60% cases needed high inotrope with prolonged ventilatory support.
Conclusion: HTK cardioplegia provides better myocardial protection in aortic valve replacement in severe aortic stenosis with hypertrophied myocardium.
Keywords: myocardial protection, del nido cardioplegia, htk cardioplegia, aortic valve surgery.
References
- Yerebakan et al, Journal of cardiothoracic surgery 2014, 9:141 DOI; 10.1186/s 13019-014-0141-5
- Modification of ischemia-Reperfusion-Induced Injury by Cardioprotective Intervention,18Ming Zhang, MD,Tamer Sallam, BS, BA, Yan-Jun Xu, PhD,and Naranjan S.Dhalla, PhD,MD (Hon),DSc (Hon).
- Patent 5,407,793. Alexandria, PA: U.S. Patent and Trademark Office; 1995.
- Charette K, Gerrah R, Quaegebeur J, et al. Single dose myocardial protection utilizing del Nido cardioplegia solution during congenital heart surgery procedures. Perfusion. 2012;27:98–103.
- Matte GS, Del Nido PJ. History and use of del Nido cardioplegia solution at Boston Children's Hospital. J Extra Corpor Technol. 2012;44:98–103.
- Heinemeyer D, Belles G, Stapenhorst K: Intracellular pH measurement during cardiac arrest in ventricular myocardium by Bretschneider’s cardioplegic solution HTK and St. Thomas Hospital solution with and without procaine. Thorac Cardiovasc Surg 35: 48–52, 1987.
- Keeling IM, Obermayr RP, Schneider B, Spieckermann PG: Postischemic cardiac function recovery in the isolated rat heart: Effects of adenosine deaminase and nucleoside transport inhibition. Langenbecks Arch Surg 385: 531–537, 2000.
- Frohlich ED, Apstein C, Chobanian AV, et al. The heart in hypertension. N Engl J Med. 1992 Oct 1;327(14):998–1008.
- Kozhevnikov D, Caref EB, El-Sherif N. Mechanisms of enhanced arrhythmogenicity of regional ischaemia in the hypertrophied heart. Heart Rhythm. 2009 Apr;6(4):522–527.
- Sambandam N, Lopaschuk GD, Brownsey RW, Allard MF. Energy metabolism in the hypertrophied heart. Heart Fail Rev. 2002 Apr;7(2):161–173.
- Gravlee GP, Davis RF, Stammers AH, Ungerleider RM, eds. Cardiopulmonary Bypass: Principles and Practice, 3rd ed Philadelphia, PA: Lippincott Williams & Wilkins; 2008:172–179, 702–4.
- Hensley FA, Martin DE, Gravlee GP. A Practical Approach to Cardiac Anesthesia, 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:649–650.
- Chambers DJ. Mechanisms and alternative methods of achieving cardiac arrest. Ann Thorac Surg.2003;75:S661–S666.
- Use of del Nido Cardioplegia for Adult Cardiac Surgery at the Cleveland Clinic: Perfusion Implications Kuna Kim, BS,* Clifford Ball, BS,* Patrick Grady, BS,* and Stephanie Mick, MD†
Corresponding Author
Kamal Das
MSc in Perfusion Sciences, Chief Perfusionist, Department of Cardiothoracic & Vascular Surgery,
R G Kar Medical College, Kolkata
DOI: https://dx.doi.org/10.18535/jmscr/v5i10.139
