International Society For Minimally Invasive Cardiothoracic Surgery

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Influence Of Low Dose Htk Cardioplegia On Immediate Outcome And Strategy In Isolated Aortic Valve Replacement
Daniele Marinelli, Donato Micucci, Francesca Faragalli, Valentina Mancini, Aziz Omar, Gabriele Di Giammarco.
Dipartimento di Neuroscienze, Imaging e Scienze Cliniche, Cattedra di Cardiochirurgia, UniversitÓ "G.D'Annunzio" Chieti-Pescara, Italy, Chieti, Italy.

OBJECTIVE
HTK solution is an intracellular, high volume single dose cardioplegia for long ischemic times.The suggested dose is related to estimated organ weight. The reported dose ranges within 10-35 ml/body weight. Mainly important is the infusion time to be kept within 8 and 10 minutes. The main drawback is volume overload with possible metabolic influence limiting its use in short-lasting operations needing strategies of volume removal. The goal of this study is to evaluate the possibility to use low doses for estimated operational times below 60 minutes. influence of different doses of HTK cardioplegia on the composite outcome of need for inotropic support or elevated CK-MB in patients submitted to isolated aortic valve replacement(AVR).

MATERIALS AND METHODS
We included in this retrospective analysis 110 first isolated aortic valve replacement by a single surgeon.We considered age,gender,left ventricular ejection fraction,chronic renal failure,diabetes, HTK dose,cross-clamping time,infusion time.Using stepwise logistic regression and ROC analysis we evaluated the influence of amount of solution infused on a composite clinical outcome of inotropic support (Dobutamine 5mcg/kg)and CK-MB release.

RESULTS
The median age of the patients was 76,13(72,5-80,5) with a prevalence of female sex(62,8%).The preoperative left ventricular ejection fraction was 60% (55,2-65).The median cross clamp time of 46 minutes(39-54).The median time of HTK cardioplegia infusion was 8 minutes(7-10) with a median dose of cardioplegia of 1500 ml and a indexed dose to body weight of 20 ml/kg(16.4-24.7).In-hospital mortality was 1,8%(2 pts).ICU and ward stay were respectively 24 hours and 6 days.The incidence of composite outcome was 35,4%(dobutamine support in 28,1% and elevated CK-MB in 7,2%).ROC analysis(FIG 1)did not demonstrate any influence of the dose of cardioplegia and the multivariate logistic regression did not identify the dose of cardioplegia as an independent predictor of the considered outcome.

CONCLUSIONS
HTK cardioplegia in patients submitted to isolated AVR is safe and efficient.The amount of HTK dose for aortic cross clamp time <= 60 minutes in this subset of patients did not influence the incidence of clinical outcome suggesting that a lower dose can be equally safe compared to high dose with the advantage to limit hemodilution and immediate cardiac function recovery without the need of excessive fluid removal.


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