Evaluation Effective Low-Volume Cardioplegia By «Custodiol» Solution

T.A. Istomin, I.S. Kurapeev

Northwestern State Medical University named after I.I. Mechnikov, Saint-Petersburg

For correspondence: Iliya S. Kurapeev – D. Sc. Med., Professor; Vladimir L. Vanevskii Department of Anaesthesiology and Reanimatology; North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg; e-mail: ikurapeev@gmail.com

For citation: Istomin TA, Kurapeev IS. Evaluation Effective Low-Volume Cardioplegia by Custodiol Solution. Intensive Care Herald. 2017;2:43–49.


The study presents the results of quality assessment of antiischemic myocardial protection by low-volume method of cardioplegia by Custodiol solution during operations with cardiopulmonary bypass. The study involved 57 patients who underwent different cardiosurgery operations with cardiopulmonary bypass. The patients were divided into two groups on the basis of the volume of cardioplegic solution. Research group (group 1) consists of 33 patients who were administered Custodiol in low volume limited by 1000 ml. The control group (group 2) consists of 24 patients who were administered standart volume of the solution corresponding to the manufacturer’s instructions: 1 ml per 1 g of myocardial mass during 6–8 minutes. The volume of Custodiol administered per 1 kg of body weight was 12.7 ± 2.0 and 22.7 ± 4 ml and 4.0 ± 1.3 and 6.3 ± 1.9 ml per 1 g of myocardial mass in groups 1 and 2, respectively (p < 0.001). The frequency of catecholamines usage, temporary cardiac pacing and other adverse events with a small-volume cardioplegia technique with Custodiol solution did not differ significantly. The results has indicated that the use of low volume of cardioplegic Custodiol in a single administration manner provides a complete antiischemic protection of the myocardium during the correction of valvular heart disease, including combination with coronary artery bypass grafting. Usage of low volume Custodiol solution method does not increase the need of inotropic and vasopressor usage and pacing time.

Keywords: myocardial protection, cardioplegia, cardioplegic solution, Custodiol 

Received: 23.02.2017 


References

  1. Семеновский М.Л., Соколов В.В., Ковалева Е.В. Клиническая оценка эффективности кардиоплегического раствора внутриклеточного типа «Кустодиола» при длительном вы- ключении сердца из кровообращения. Грудная и сердечно-сосудистая хирургия. 1998; 4: 20–23. [Semenovskii M.L., Sokolov V.V., Kovaleva E.V. Klinicceskaya otsenka effektivno- sti kardioplegicheskogo rastvora vnutrikletochnogo tipa Kusto- diol pri dlitel’nom vyklyuchenii serdtsa iz krovoobrashcheniya. Grudnaya i serdechno-sosudistaya hirurgiya. 1998; 4: 20–23. (In Russ)]
  2. Положий Д.Н. Сравнительная оценка эффективности защиты миокарда с применением раствора Бретшнайдера и кровяной кардиоплегии при хирургической коррекции кла- панной патологии и ИБС: Дис. … канд. мед. наук. М., 2013. [Polozhii D.N. Sravnitel’naya otsenka effektivnosti zashchity miokarda s primeneniem rastvora Bretshnaidera i krovyanoi kar- dioplegii pri khirurgicheskoi korrektsii klapannoi patologii i IBS [dissertation]. Moscow, 2013. (In Russ)]
  3. Edelman J.J.B., Seco M., Dunne B. et al. Custodiol for myo- cardial protection and preservation: a systematic review. Cardiothoracic 2013; 2: 717–728.
  4. Инструкция по медицинскому применению препарата «Кустодиол» [электронный ресурс]. URL: http://кустодиол.рф/php [Instruktsiya po meditsinskomu primeneniyu preparata Kustodiol [Internet]. URL: http://кустодиол.рф/instruction.php (In Russ)]
  5. Лоскутов О.А. Оценка эффективности кардиоплегического раствора Бретшнайдера при аортокоронарном шунти- ровании. Український журнал екстремальної медицини ім. Г.О. Можаєва. 2013; 14(1): 95–98. [Loskutov O.A. Otsenka effektivnosti kardioplegicheskogo rastvora Bretshnaidera pri aortokoronarnom shuntirovanii. Ukrainskii zhurnal ekstremal’noi meditsiny G.O. Mozhaeva. 2013; 14(1): 95–98. (In Russ)]
  6. Arslan , Sezgin A., Gultekin B. et al. Low-Dose Histidine-Tryp- tophane-Ketodlutarate for Myocardial Protection. Transplanta- tion Proceeding. 2005; 37: 3219–3222.
  7. Braathen B., Jeppsson А., Schersten H. et al. One single dose of histidine-tryptophan-ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repeti- tive cold blood cardioplegia: A prospective randomized J. Thorac. Cardiovasc. Surg. 2011; 141(4): 995–1001.
  8. Lueck S., Preusse C.J., Welz A. Clinical relevance of HTK-induced hyponatremia. Ann. Thorac. Surg. 2013; 95(5): 1844– 1845.
  9. Scott D.A., Tung M., Slater R. Perioperative Hemoglobin Trajectory in Adult Cardiac Surgical Patients. J. Extra Corpor. Tech- nol. 2015; 47(3): 167–173.
  10. Пантеева О.Н., Александров Н.Ю., Лебединский К.М. Глубина анестезии и ее стабильность при операциях с использованием искусственного кровообращения. Эфферентная терапия. 2009; 15(3–4): 101–106. [Panteeva O.N., Alexandrov N.U., Lebedinskii K.M. Glubina anestezii i ee its stabil’nost’ pri operatsiyah s ispol’zovaniem iskusstvennogo krovoobrashcheniya. Efferentnaya terapiya. 2009; 15(3–4): 101–106. (In Russ)]
  11. Sanjay P., Srikrishna S.V., Prashanth P. et al. Antegrade versus antegrade with retrograde delivery of cardioplegic solution in myocardial revascularisation. A clinical study in patients with triple vessel coronary artery disease. Ann. Card. Anaesth. 2003; 6(2): 143–148.
  12. Buckberg G.D., Beyersdorf , Kato N.S. Technical considerations and logic of antegrade and retrograde blood cardioplegic delivery. Semin. Thorac. Cardiovasc. Surg. 1993: 5(2): 125–133.
  13. Yilik L., Ozsoyler I., Yakut et al. Passive infusion: a simple delivery method for retrograde cardioplegia. Tex. Heart Inst. J. 2004; 31(4): 392–397.
  14. Трекова Н.А., Аксельрод Б.А., Юдичев И.И. и др. Клинические аспекты динамики лактата крови во время операций на сердце и аорте в условиях искусственного кровообращения. Анестезиология и реаниматология. 2016; 61(5): 324–329. [Trekova N.A., Akselrod B.A., Yudichev I.I. et al. Klinicheskie as- pekty dinamiki laktata krovi vo vremya operatsii na serdtse i aor- te v usloviyah iskusstvennogo krovoobrashcheniya. Anesteziol. i 2016; 62(5): 26–31. (In Russ)]
  15. Murphy G.S., Hessel E.A. 2nd, Groom R.C. Optimal perfusion during cardiopulmonary bypass: an evidence-based approach. Anesth. Analg. 2009; 108(5): 1394–1417.
  16. Kim T., Park Y.H., Chang Y.E. et al. The effect of cardioplegic solution-induced sodium concentration fluctuation on postoperative seizure in pediatric cardiac patients. Ann. Thorac. Surg. 2011; 91(6): 1943–1948.
  17. Lindner G., Zapletal B., Schwarz Ch. et al. Acute hyponatremia after cardioplegia by histidine-tryptophane-ketoglutarate — a retrospective J. of Cardiothoracic Surgery. 2012; 7: 1–5.
  18. Hensley A. Jr, Gravlee G.P., Martin D.E. A Practical Approach to Cardiac Anesthesia, 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott, Williams & Wilkins, 2012.
  19. Чарная М.А., Дементьева И.И., Морозов Ю.А. и др. Кардиоспецифические биомаркеры в кардиологии и кардиохирургии. Кардиология и сердечно-сосудистая хирургия. 2010; 4: 10–16. [Charhaya M.A., Dement’eva I.I., Morozov Yu.A. et al. Kardiospetsificheskie biomarkery v kardiologii i kardiohirurgii. Kardiologiya i serdechno-sosudistaya 2010; 4: 10–16. (In Russ)]
  20. Задорожная М.П., Разумов В.В. Спорные вопросы эхокардиографического определения массы миокарда левого желудочка и его гипертрофии (Аналитический обзор и собственные наблюдения). Современные проблемы науки и образования. 2015; 6: 216–225. [Zadorozhnaya M.P., Razumov V.V. Spornye voprosy ehokardiograficheskogo opredeleniya massy miokarda levogo zheludochka i ego gipertrofii (Analiticheskii ob- zor i sobstvennye nabludeniya). Sovrenennye problemy nauki i obrazovaniya. 2015; 6: 216–225. (In Russ)]
  21. Ferguson Z.G., Yarborough D.E., Jarvis B.L., Sistino J.J. Evidence-based medicine and myocardial protection — where is the evidence? Perfusion. 2015; 30(5): 415–422.