CUSTODIOL® HTK Solution for Myocardial Protection During an Aortic Valve Replacement and CABGx2

READER COMMENTS

By Timothy H. Trotter, MD, FACS, FCCP and Colette Calame, CCP

The open heart surgery shown in this video consists of an aortic valve replacement and CABG times two in a 63-year-old male with severe aortic stenosis, moderate AI, and coronary artery disease. The procedure was prolonged due to the patient’s severe coronary calcification and difficulty seating a 21mm Onyx valve in a small annulus. The cardioplegia solution used for this procedure was CUSTODIOL® HTK, delivered down the aortic root over six minutes and an additional volume given retrograde and down each coronary ostia because of the AI. After successful heart arrest, the patient underwent the aortic valve replacement. The cross clamp was removed after 1hour 32 minutes of arrest. The heart spontaneously resumed normal sinus rhythm as noted via the EKG. The heart exhibited excellent function as evidenced by good contractility both by ECHO and visually.

A Note from the Perfusionist:

“CUSTODIOL® HTK is a hyper-polarizing cardioplegia and because of the large histidine buffer concentration, there is no room, osmolality wise, for normal Na+ levels. This is why the Na+ drops. It does not cause harm to the patient, and can be easily fixed with DUF (dilutional ultrafiltration with NaHCO3 buffered 0.9% NCL soultion) as mentioned in the video.”