Myocardial Protection by Retrograde Application of Bretschneider Cardioplegia during Heart Valve Surgery
Thiti Chanmayka MD1, Chalach Mitprachapranee MD1, Chawalit Wongbhuddha MD1, Sompop Prathanee MD1, Chusak Kuptanond MD1
Affiliation : 1 Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background : Bretschneider or Histidine-Tryptophan-Ketoglutarate (HTK or Custodiol) cardioplegic solution provides
protection for more than 2 hours of myocardial ischemia. It is convenient to require only single dose.
Objective : To present outcomes of using single dose of retrograde HTK solution for double valve replacement [DVR] and
tricuspid valve annuloplasty [TVA] surgery at Khon Kaen University.
Materials and Methods : Twenty-two patients were treated by DVR and TVA using single dose of retrograde HTK solution
between January 2013 and April 2017. Data included demographics, operative data, early outcomes, serum cardiac enzyme
markers, complications and peri-operative mortality.
Results : The mean age of patients was 49.27+10.6 years and 50% were female. Left ventricular ejection fraction was
53.52+16.3%, aortic cross clamp time was 94.8+13.3 minutes, cardiopulmonary bypass time was 125.13+20.3 minutes,
spontaneous ventricular fibrillation was 40.9%, and no mortality.
Conclusion : The use of single dose of retrograde HTK cardioplegia for DVR and TVA surgery is feasible, convenient and
acceptable early outcomes. HTK solution may be applicable to a broader range of cardiac surgery compared with multiple
doses of cold blood cardioplegia.
Keywords : Cardioplegia, Custodiol, DVR, HTK, TVA
