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International Society For Minimally Invasive Cardiothoracic Surgery

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Effects Of Custodiol-htk And Del Nido Solutions In A Coronary-perfused Rabbit Ventricular Wedge Model
Serge Sicouri, MD1, Gan-Xin Yan, MD, PhD1, Tengxian Liu1, Vishal Shah, DO1, Debbie Spivak1, Summer Sedano1, Lisa Laury-Kleintop, PhD1, Konstadinos A. Plestis, MD2.
1Lankenau Institute for Medical Research, Wynnewood, PA, USA, 2Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.

Background: Distinct cardioplegic solutions are used in cardiac surgery for myocardial protection. Custodiol-HTK (CUS) solution consists of histidine, tryptophan, ketoglutarate and mannitol to reduce cellular edema. Del Nido (DN) is a nonglucose-based solution containing low calcium and high lidocaine concentrations, indirectly preventing intracellular Ca2+ accumulation during ischemia. This study compares the effects of CUS and DN on ECG and tension parameters in a rabbit experimental model. Methods: Ten left ventricular (LV) wedge preparations from 10 rabbit hearts were arterially perfused with Tyrode's solution and stimulated at a cycle length of 1000 ms. Simultaneous recording of transmural ECG and tension were obtained. After exposure to normal Tyrode for preparation of the LV wedge, the preparation was perfused with 20 cc of CUS (n=5) or 20 cc of DN (n=5) leading to complete arrest. The duration of the arrest was 1 h. After that, reperfusion with Tyrode solution was initiated. ECG and tension recordings were obtained under control, in the immediate postischemic period and for 60 min after reperfusion with normal Tyrode. Results: CUS and DN solutions stopped electrical and tension activity in 1 to 3 min. The reperfusion effects of CUS and DN on ECG and tension are shown in table 1. After arrest, reperfusion with normal Tyrode solution led to wider QRS in DN group. Also, maximum ST segment elevation was larger in the DN group compared to the CUS group (0.4 + 0.2 vs 0.9 + 0.4 mm, p=0.027). Negative T wave were observed in 1 of 5 wedges of the CUS group and in 3 of 3 of the DN group. Severe arrhythmias were observed only in DN group, including VF in 2 of 5 wedges. Conduction block was observed only in the DN group in 3 of 5 wedges. Tension recovery after 30 min of reperfusion was 69% and 19% in CUS and DN groups. Conclusions: In the LV coronary-perfused rabbit wedge preparation, Custodiol-HTK cardioplegia led to less electrical changes and better tension recovery at 1 hr. These results need further evaluation.


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