Table 2.

Categories of cardioplegia strategies used for cardioprotection, with example solutions, representative component concentrations, and additives for each category

Cardioplegia Type	Example Solutions and Concentrations	Na+, mM/L	K+, mM/L	Mg2+, mM/L	Ca2+, mM/L	HTK, mM/L	Mannitol	Glucose, mM/L	Lidocaine	Adenosine	NaHCO3	Modifications:
Crystalloid-based
Intracellular	Custodiol, HTK, Bretschneider’s, University of Wisconsin Solution	15	9	4	0.015	198/2/1	x					Glutamate, aspartate
Extracellular	Plegisol, Celsior, St Thomas, Stanford solution	110–120	16–26	32	2.4		x					Glutamate, aspartate
Blood-based (includes endogenous oxygen carrying, substrates, buffers, antioxidants, oncotic pressure, inflammatory factors)
4:1 Blood:crystalloid	Buckberg	140	20–10 (i-m)	13–9 (i–m)				6	260 mg/L (induction)			Glutamate, aspartate, CPD, tromethamine
1:4 Blood:crystalloid, long-acting	del Nido (in 1 L Plasma-Lyte A)	Plasma-Lyte	26 meq	2 mg			3.2 g		130 mg		13 meq	Glutamate, aspartate
Microplegia (blood-based cardioplegia principles apply; with relatively less edema, increased neutrophil accumulation and endothelial dysfunction)
Various additive and concentration options	ALM with insulin (8 mL additive:l L blood)		30–8 meq/L (i-m)	2 g/20 mL					25 mg/l mL	6 mg/2 mL		2.5 IU Insulin added to ALM volume

Abbreviations: ALM, adenosine and lidocaine with magnesium; CPD, citrate-phosphate-dextrose; HTK, histidine, tryptophan, ketoglutarate; i-m, concentrations for induction or maintenance of cardioplegia; Plasma-lyte A concentrations/L (Baxter), 140 mEq sodium, 5 mEq potassium, 3 mEq magnesium, 98 mEq chloride, 27 mEq acetate, and 23 mEq gluconate; x, may be added as a modifier.

Component and additive concentration information is for reference and comparison between solutions only; not for clinical use. Data from Refs.^87–90