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Updated: May 7, 2025
Pre-clinical Model of Cardiac Donation after Circulatory Death
Published on: August 2, 2019
Comparison of Del Nido and histidine-tryptophan-ketoglutarate cardioplegia solutions: an animal study with prolonged
Alexandro Hoyer1, Maja-Theresa Dieterlen1, Jagdip Kang1
1Heart Centre Leipzig, University Clinic of Cardiac Surgery, HELIOS Clinic, University Leipzig, Leipzig, Germany.
Insights
Del Nido cardioplegia (DN) demonstrated superior myocardial protection compared to histidine-tryptophan-ketoglutarate (HTK) cardioplegia in a porcine model. DN improved left ventricular function and reduced endothelial injury, while HTK led to significant electrolyte imbalances and a higher need for defibrillation.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Experimental Medicine
Background:
- Myocardial protection is crucial for successful cardiac surgery.
- Cardioplegia is the cornerstone of myocardial protection during procedures.
- Comparing different cardioplegic solutions is essential for optimizing patient outcomes.
Purpose of the Study:
- To compare the cardioprotective effects of Del Nido cardioplegia (DN) and Bretschneider histidine-tryptophan-ketoglutarate cardioplegia (HTK).
- To evaluate these effects in a porcine model subjected to prolonged ischemia and reperfusion.
Main Methods:
- Landrace pigs (n=18) were randomized to receive either DN or HTK cardioplegia.
- Animals underwent 90 minutes of cardiac arrest followed by 120 minutes of reperfusion.
- Comprehensive laboratory, histological, and functional parameters were assessed.
Main Results:
- Del Nido cardioplegia (DN) showed significantly better left ventricular systolic and diastolic function compared to HTK.
- DN maintained higher hemoglobin and electrolyte levels and required fewer defibrillations for sinus rhythm restoration.
- DN also exhibited lower ICAM-1 expression, indicating reduced endothelial dysfunction, while histological and oxidative stress markers were comparable.
Conclusions:
- Del Nido cardioplegia (DN) is superior to histidine-tryptophan-ketoglutarate (HTK) cardioplegia in a porcine model of prolonged ischemia.
- DN offers better preservation of left ventricular function, electrolyte balance, and endothelial integrity.
- While DN showed advantages, key markers of ischemia/reperfusion injury, oxidative stress, and apoptosis were similar between the two solutions.
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) vs. 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).
Conclusions:
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.
