Hyponatremia may seem like a small number on a lab report, but in aortic valve surgery it can have outsized consequences - especially when Histidine-Tryptophan-Ketoglutarate (Bretschneider HTK) cardioplegia is used. HTK is valued worldwide for its gentle, long acting myocardial protection, enabling surgeons to work with a quiet, well preserved heart during complex valve procedures. Its low sodium formulation, however, naturally raises the question: Does it matter for patient outcomes? 

A new clinical analysis from Târgu Mureș provides compelling clarity. Among 302 patients undergoing aortic valve replacement, preoperative hyponatremia - not the transient sodium drop after HTK infusion - proved to be the true predictor of complications, reintervention, and early mortality. Remarkably, the expected postoperative dilutional hyponatremia showed no harmful effect, underscoring the safety of HTK cardioplegia when applied within modern perfusion strategies such as routine ultrafiltration. The message is clear and clinically relevant: HTK remains a highly effective and safe cardioplegic solution, but baseline sodium matters and recognizing it early can change outcomes.

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