Comparison between the Effects of Bretschneider’s HTK Solution and Cold Blood Cardioplegia on Systemic Endothelial Functions in Patients who Undergo Coronary Artery Bypass Surgery: a Prospective Randomized and Controlled Trial

Abstract Objective: To investigate the effects of Bretschneider’s histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegia on systemic endothelial functions. Methods: A total of 50 patients who underwent isolated coronary artery bypass surgery between March 2018 and May 2018 were randomly divided into two groups - group 1 (Bretschneider’s HTK solution, n=25) and group 2 (cold blood cardioplegia, n=25). Data related to the indicators of endothelial dysfunction were recorded. Flow-mediated dilation was measured together with the assessment of the values of endothelin-1, von Willebrand factor, and asymmetric dimethylarginine to identify endothelial dysfunction. Then, the two groups were compared regarding these values. Results: The most significant result of our study was that the endothelin-1 level was significantly higher in group 2 than in group 1 (P<0.001). The value of flow-mediated dilation was found to increase to a lesser degree on the postoperative days compared to the value at the day of admission in group 1 (P=0.002 and P=0.030, respectively). Conclusion: Cardiopulmonary bypass leads to endothelial dysfunction. Our results revealed that Bretschneider’s HTK solution causes less severe endothelial injury than cold blood cardioplegia.

摘要
研究目的：探讨布雷茨奈德组氨酸-色氨酸-酮戊二酸（Bretschneider’s histidine-tryptophan-ketoglutarate, HTK）溶液与冷血停搏液对全身内皮功能的影响。
研究方法：选取2018年3月至2018年5月期间行单纯冠状动脉旁路移植术的50例患者，采用随机分组法将其分为两组——组1（布雷茨奈德HTK溶液组，n=25）与组2（冷血停搏液组，n=25）。记录与内皮功能障碍相关的临床数据；通过检测内皮素-1（endothelin-1）、血管性血友病因子（von Willebrand factor）及不对称二甲基精氨酸（asymmetric dimethylarginine）的水平，并结合血流介导的血管舒张功能（flow-mediated dilation, FMD）检测结果，评估患者内皮功能障碍情况，随后对比两组的上述指标水平。
研究结果：本研究最显著的结果为，组2的内皮素-1水平显著高于组1（P<0.001）。组1患者术后各日的血流介导的血管舒张功能值较入院当日的升高幅度均更小，差异具有统计学意义（分别为P=0.002与P=0.030）。
研究结论：体外循环（cardiopulmonary bypass）可导致内皮功能障碍。本研究结果显示，布雷茨奈德HTK溶液所致的内皮损伤程度较冷血停搏液更轻。