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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Clinical and Translational Cardiovascular Medicine
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1457770

Comparison of Del Nido and histidine-tryptophan-ketoglutarate cardioplegia solutions: an animal study with prolonged ischaemia

Provisionally accepted
Alexandro Hoyer Alexandro Hoyer Maja-Theresa Dieterlen Maja-Theresa Dieterlen *Jagdip Kang Jagdip Kang Hanna Oetzel Hanna Oetzel Karoline Wiesner Karoline Wiesner Kristin Klaeske Kristin Klaeske Philipp Kiefer Philipp Kiefer Susann Oßmann Susann Oßmann Andre Ginther Andre Ginther Martin Kostelka Martin Kostelka Suzanne de Waha Suzanne de Waha Michael Andrew Borger Michael Andrew Borger
  • University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany, Leipzig, Germany

The final, formatted version of the article will be published soon.

    Objective: Myocardial protection is important for a successful procedure cardiac surgery, and the key element of myocardial protection is cardioplegia. We compared Del Nido cardioplegia (DN) and Bretschneider histidine-tryptophan-ketoglutarate cardioplegia (HTK) regarding cardioprotective effects in a porcine model of prolonged ischaemia. Methods: Landrace pigs weighing 50-60 kg were randomized to receive either DN (n=9) or HTK (n=9). All pigs underwent cardiac arrest for 90 min followed by 120 min of reperfusion/convalescence. A detailed set of laboratory, histological and functional parameters was acquired at baseline, during cardiac arrest and following reperfusion/convalescence.Results: Pressure-volume measurements revealed better systolic and diastolic left ventricular performance in DN as compared to HTK (both p<0.05). Haemoglobin decreased after application of the cardioplegic solution. The decrease was more pronounced in the HTK group than in the DN group (p<0.01). In contrast to DN, sodium (p<0.01) and chloride levels (p<0.05) were significantly decreased in the HTK group after initiation of CPB and remained decreased after reperfusion. The number of animals requiring defibrillations to restore sinus rhythm significantly differed between the groups (HTK: 100% [n=9/9] versus DN: 44.4% [n=4/9], p=0.03). Expression of ICAM-1 as a marker of endothelial dysfunction was lower in the DN group compared to the HTK group (p=0.02). Histological evaluation, oxidative and nitrosative stress, mitochondrial membrane integrity and apoptosis markers were comparable between DN and HTK groups (all p>0.05).In this porcine model with prolonged ischaemia, DN was superior to HTK in terms of haemoglobin levels, blood electrolytes, spontaneous return of sinus rhythm, left ventricular function, and endothelial injury. Histomorphological parameters indicative of ischaemia/reperfusion injury, oxidative stress and mitochondrial function as well as apoptosis-inducing factors did not differ.

    Keywords: Del nido solution, Bretschneider solution, Histidine-tryptophan-ketoglutarate solution, Custodiol, single shot cardioplegia, animal model, ischaemia

    Received: 01 Jul 2024; Accepted: 18 Nov 2024.

    Copyright: © 2024 Hoyer, Dieterlen, Kang, Oetzel, Wiesner, Klaeske, Kiefer, Oßmann, Ginther, Kostelka, de Waha and Borger. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Maja-Theresa Dieterlen, University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany, Leipzig, Germany

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