2021 SCPS AGM
SPEAKER ABSTRACTS
05-07 NOVEMBER 2021

Histidine Tryptophan Ketoglutarate vs Extracellular Crystalloid cardioplegia in endoscopic minimally invasive mitral valve surgery using endoaortic clamping: a proposal for a prospective randomised study comparing neurological outcomes, efficacy, and safety.

Alice Polkinghorne

Trainee Clinical Perfusionist

DAY 2 SPEAKER
STUDENT

Minimally invasive mitral valve surgery (MIMVS) provides benefits including a shorter recovery time and more aesthetically pleasing scar, whilst resulting in similar valve repair quality to sternotomy. MIMVS can be performed endoscopically using a thoracoscope and endoaortic clamping (EAC). EAC is not currently a widely used method of cross clamping. However, it can confer advantages when used by a well-trained team, especially in the setting of a calcified aorta or redo procedure.

The EAC occludes the aorta by balloon inflation and cardioplegia is delivered down a central lumen. This central lumen requires a crystalloid cardioplegia solution. Histidine-tryptophan-ketoglutarate (HTK) is a form of single-dose intracellular crystalloid cardioplegia, which could shorten surgery time. However, it is a low sodium solution and causes systemic hyponatraemia. Hyponatraemia is known to cause cerebral swelling and can cause cognitive decline, although the hyponatraemia has been shown to be isotonic, a less dangerous form.

To test this, 334 endoscopic MIMVS patients will be randomised to receive HTK or multi-dose extracellular crystalloid cardioplegia (EC). The study will examine the change in cognitive function before and after HTK compared to EC. The tonicity of the hyponatraemia will also be determined. The secondary outcome of the study is to determine if HTK provides a similar level of cardio-protection to EC by testing levels of ischaemic markers following surgery. of surgery will also be compared.

Previous HTK studies have not investigated a change from baseline cognitive function, and no randomised studies using HTK with EAC exist. The aim of this research is to elucidate the safest, most efficacious cardioplegia to use in MIMVS with EAC.

MIMVS is offered at few cardiac centres in the UK, meaning patients miss out. Results of this study will give surgeons a proven myocardial protection method to use and encourage more centres to begin MIMVS.

PRE-RECORDED VIDEO OF 2021 AGM PRESENTATION AVAILABLE?
YES
Videos that have been pre-recorded will be available in our member's area on the website by 12/11/2021. Additional submissions will be added where possible.

SPEAKER PROFILE

Alice is a recently qualified perfusionist from Blackpool Victoria Hospital after completing the MSc in Perfusion Science in September 2021. Alice also has a BSc in Anatomy and Human Biology from the University of Liverpool which she completed in 2019 prior to starting her trainee perfusionist post. Alice’s research project for the MSc is a study proposal comparing HTK with extracellular crystalloid cardioplegia alongside use of the endoaortic clamp in minimally invasive mitral valve surgery. This is with the aim to elucidate the best cardioplegia to use with the endoaortic clamp which could help aid with decisions regarding its use.

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