{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T17:15:39Z","timestamp":1765041339077,"version":"3.28.0"},"reference-count":42,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003We compared the effect of intermittent blood and histidine-tryptophan-ketoglutarate (HTK) solution of Bretschneider on myocardial histopathology and perioperative outcome.<\/jats:p><jats:p>\n          Methods\u2003Forty adult cardiac surgery patients were grouped into two (n\u2009=\u200920 for each): (1) Intermittent blood cardioplegia (IBC): had repeated cold 4:1 blood cardioplegia and (2) HTK: had a single dose of cold HTK for cardioprotection. Creatine kinase (CK)-MB, Troponin-I (cTn-I), pH, and lactate were studied in coronary sinus blood before and after aortic cross-clamping (AXC) and systemic blood at postoperative 6th, 24th, and 48th hours. Myocardial biopsy was performed before and after AXC for light microscopy. Vacuolation, inflammation, edema, and glycogen were graded semiquantitatively (from 0 to 3). The myocardial apoptotic index was evaluated via the terminal deoxynucleotidyl transferase dUTP nick end labeling.<\/jats:p><jats:p>\n          Results\u2003There were no differences in perioperative clinical outcomes between the groups. The coronary sinus samples after AXC were more acidotic (7.15\u2009\u00b1\u20090.14 vs. 7.32\u2009\u00b1\u20090.07, p\u2009=\u20090.001) and revealed higher CK-MB (21.0\u2009\u00b1\u200912.81 vs. 12.60\u2009\u00b1\u200911.80, p\u2009=\u20090.008) in HTK compared with IBC. The HTK had significantly a higher amount of erythrocyte suspension intraoperatively compared with IBC (0.21\u2009\u00b1\u20090.53 vs. 1.68\u2009\u00b1\u20090.93 U, p\u2009=\u20090.001). Microscopically, myocardial edema was more pronounced in HTK compared with IBC after AXC (2.25\u2009\u00b1\u20090.91 vs. 1.50\u2009\u00b1\u20090.04, p\u2009=\u20090.013). While a significant increase in the apoptotic index was seen after AXC in both groups (p\u2009=\u20090.001), no difference was detected between the groups (p\u2009=\u20090.417).<\/jats:p><jats:p>\n          Conclusion\u2003IBC and HTK have a similar clinical outcome and protective effect, except for more pronounced myocardial edema and increased need for intraoperative transfusion with HTK.<\/jats:p>","DOI":"10.1055\/s-0042-1759710","type":"journal-article","created":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T23:38:10Z","timestamp":1673653090000},"page":"011-020","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of Bretschneider HTK and Blood Cardioplegia (4:1): A Prospective Randomized Study"],"prefix":"10.1055","volume":"72","author":[{"given":"Koray","family":"Ak","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Marmara University School of Medicine, Marmara Uninersitesi Hastanesi Mimar Sinan Cad. Fevzi Cakmak Mah. Ust Kaynarca Kalp ve Damar Cerrahisi Bolumu Pendik, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Okan","family":"Dericio\u011flu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Marmara University School of Medicine, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmet","family":"Midi","sequence":"additional","affiliation":[{"name":"Department of Pathology, Bahcesehir University, School of Medicine, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alper","family":"Kararmaz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zafer","family":"Er","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Bozok University Faculty of Medicine Ringgold Standard Institution, Yozgat, Yozgat, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeynep","family":"Do\u011fusan","sequence":"additional","affiliation":[{"name":"Department of Pathology, Bone Marrow Transplantation Unite, Yeni Y\u00fczy\u0131l University School of Medicine, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sinan","family":"Arsan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Marmara University School of Medicine, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,1,13]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.ejcts.2010.03.052","article-title":"Cold blood versus cold crystalloid cardioplegia: a prospective randomised study of 345 aortic valve patients","volume":"38","author":"E \u00d8vrum","year":"2010","journal-title":"Eur J Cardiothorac Surg"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1510\/icvts.2008.178343","article-title":"Is blood cardioplegia superior to crystalloid cardioplegia?","volume":"7","author":"S Jacob","year":"2008","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1540-8191.2008.00651.x","article-title":"Use of (all-blood) miniplegia versus crystalloid cardioplegia in an experimental model of acute myocardial ischemia","volume":"23","author":"O Petrucci","year":"2008","journal-title":"J Card Surg"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/0003-4975(95)00422-H","article-title":"The physiologic basis of warm cardioplegia","volume":"60","author":"M C Mauney","year":"1995","journal-title":"Ann Thorac Surg"},{"issue":"S 02","key":"ref5","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1055\/s-2007-1013086","article-title":"Clinical experience with blood cardioplegia","volume":"46","author":"C Schlensak","year":"1998","journal-title":"Thorac Cardiovasc Surg"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1016\/j.jtcvs.2009.05.036","article-title":"Cold blood cardioplegia reduces the increase in cardiac enzyme levels compared with cold crystalloid cardioplegia in patients undergoing aortic valve replacement for isolated aortic stenosis","volume":"139","author":"B Braathen","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.athoracsur.2013.05.052","article-title":"Current cardioplegia practice in pediatric cardiac surgery: a North American multiinstitutional survey","volume":"96","author":"Y Kotani","year":"2013","journal-title":"Ann Thorac Surg"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"714","DOI":"10.21037\/jtd.2018.01.133","article-title":"Comparison of the different cardioplegic strategies in cardiac valves surgery: who wins the \u201carm-wrestling\u201d?","volume":"10","author":"G Comentale","year":"2018","journal-title":"J Thorac Dis"},{"issue":"02","key":"ref9","first-page":"15","article-title":"Custodiol cardioplegia: a single-dose hyperpolarizing solution","volume":"48","author":"C J Preusse","year":"2016","journal-title":"J Extra Corpor Technol"},{"issue":"31","key":"ref10","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1093\/eurheartj\/ehx383","article-title":"ESC Joint working groups on cardiovascular surgery and the cellular biology of the heart position paper: perioperative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery","volume":"38","author":"M Thielmann","year":"2017","journal-title":"Eur Heart J"},{"issue":"04","key":"ref11","first-page":"547","article-title":"Protection of the hypertrophied pig myocardium. 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