الفهرس 
Glucose for the HeartOnly 14 pages are availabe for public view
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Abstract
Background: Glycogen is an immediate source of glucose for normal cardiac tissue to maintain its metabolic homeostasis, in severe ischemia myocardial glucose extraction is inversely related to coronary flow, until the degree of ischemia becomes so severe that glycolysis is inhibited by the accumulation of its products. Once glycolysis is inhibited glucose uptake progressively decreases, Inadequate myocardial protection in long ischaemic periods followed by reperfusion is an issue of concern in cardiac surgery. Cardioplegic solutions improve the tolerance to ischaemia and reperfusion by preserving myocardial energy reserve, preventing osmotic and electrolyte imbalance and buffering acidosis. Also the effect of cardioplegia in general decreases myocardial glycogen storage.
In this study we aimed to assess the efficacy of the HTK solution when compared with our standard blood cardioplegia in coronary artery bypass graft operations via assessment of myocardial glycogen storage as a primary outcome. Also to compare Bypass time, cross clamp time, Number of grafts, the incidence of spontaneous defibrillation, ICU Stay, duration of using Inotropes, Duration of Ventilation, post-operative blood loss, postoperative hospital stay, and Post-operative echocardiography findings in both groups as secondary outcomes.
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Patients and Methods: This was Randomized controlled study conducted on 40 consecutive patients who underwent isolated elective CABG .
Inclusion criteria: Any primary native patient who required elective CABG operation.
Exclusion criteria: Age more than 70. Any patient diagnosed to have any glycogen storage disease. Unstable angina (class III or IV). Poor left ventricular function (LVEF <40%). Patient with acute MI. Previous PCI or CABG. Previous renal failure. Any congenital lung disease. Preoperative Aortic valve disease required replacement. Preoperative Mitral valve disease required replacement. Patient requires Emergent CABG operation Technique: Surgical approach will be via median sternotomy. Before initiating the cardiopulmonary bypass (CPB) a Myocardial tissue sample will be taken from right ventricle (RV) through trucut biopsy and stored in an eppendorf tube at -20°C, each biopsy will be weighted then homogenized in 200ul phosphate buffer saline (PBS), the homogenate will be centrifuged at 10000xg then supernatant to be used in determination of glycogen by ELISA kit. And there is previous study do the same surgical technique and it is totally safe(9). The cardiopulmonary bypass (CPB) will be established by an arterial cannula in the ascending aorta. Venous drainage will be obtained via a two-stage cannula in the right atrium or bicaval cannulation through the superior and inferior vena cavae. Under CPB and aortic cross-clamping, cardioplegic arrest will be induced. In the HTK (Custodiol; Koehler Chemi, Alsbach-Haenlien, Germany) group, systemic temperature will be lowered to 28°C. The HTK solutions at 4°C will be given in an antegrade fashion at an initial perfusion pressure of 80–100 mmHg. In the blood-cardioplegia group, systemic temperature will be reduced to 30°C, or lower. One litre of blood induction cardioplegia will be given with the antegrade route. Blood maintenance cardioplegia will be repeated every 30–45min. After coming of bypass another Myocardial tissue sample will be taken for assessment of mycordial glycogen storage (9
The outcome of this study: The outcome of this study is prove that there is no difference between normal blood cardioplegia and HTK solution in open heart surgery through assessment of glycogen storage in myocardial tissue.
Results: As regards to our primary outcome glycogen storage in myocardium there was statistically significant difference in each group pre and postoperative regarding Glycogen storage in myocardium within the same group. But there was no statistically significant difference when comparing Glycogen storage in myocardium post-operative in both groups. As regards to Bypass time, cross clamp time, Number of grafts, ICU Stay, postoperative hospital stay, Duration of Ventilation, post-operative blood loss & duration of using Inotropes there were no statistically significant difference between both studied groups. Also Echocardiography findings post-operative there was no statistically significant difference in both groups.
Conclusion: Custodiol cardioplegia (HTK) is an easy technique and simple without need of preparation or repeated administration is an alternative to blood cardioplegia with no difference regarding glycogen storage in myocardium