Comparative Analysis of Myocardial Protection with HTK Solution and Hypothermic Hyperkalemic Blood Solution in the Correction of Acyanogenic Congenital Cardiopathies – A Randomized Study

Abstract

Objective The goal of the present study was to compare the myocardial protection obtained with histidine-tryptophan-ketoglutarate (HTK) cardioplegic solution (Custodiol ® ) and with intermittent hypothermic blood solution. Methods Two homogenous groups of 25 children with acyanotic congenital heart disease who underwent total correction with mean aortic clamping time of 60 minutes were evaluated in this randomized study. Troponin and creatine kinase-MB curves, vasoactive-inotropic score, and left ventricular function were obtained by echocardiogram in each group. The values were correlated and presented through graphs and tables after adequate statistical treatment. Results It was observed that values of all the studied variables varied over time, but there was no difference between the groups. Conclusion We conclude that in patients with acyanotic congenital cardiopathies submitted to total surgical correction, mean aortic clamping time around one hour, and cardiopulmonary bypass with moderate hypothermia, the HTK crystalloid cardioplegic solution offers the same myocardial protection as the cold-blood hyperkalemic cardioplegic solution analyzed, according to the variables considered in our study model.

Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management

“…A single-dose HTK perfusion regimen is becoming more frequent in technically complex heart surgeries requiring a long AC. The median AC time in this study cohort was above 80 min, which is consistent with previous studies where AC time exceeded 60 min [5,14] . This retrospective study aimed to investigate the clinical influence of high dosage HTK perfusion on neonatal patients.…”

“…The median AC time in this study cohort was above 80 min, which is consistent with previous studies where AC time exceeded 60 min. [ 5 , 14 ] This retrospective study aimed to investigate the clinical influence of high dosage HTK perfusion on neonatal patients. The HTK dosage in the high-dose group was significantly higher than in previous studies.…”

“…Many studies recommend a single shot of 40 to 60 mL/kg HTK perfused into the aortic root for 5 to 6 min, with an initial pressure of 80 to 100 mmHg. When the myocardium is at standstill, perfusion pressure should be reduced to 40 to 60 mmHg [3–7] . However, all these studies were based on adult or older pediatric patients.…”

“…When the myocardium is at standstill, perfusion pressure should be reduced to 40 to 60 mmHg. [3][4][5][6][7] However, all these studies were based on adult or older pediatric patients. Due to the different physiology of neonatal patients, it is difficult to maintain perfusion time, pressure, and dosage simultaneously.…”

Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia

“…In group A, the mean ejection fraction after the valvular replacement was higher compared to group B (53.17 ± 7.73 compared with 49.06 ± 7.170) [ 89 ]. Other recent surveys did not find statistical differences in myocardial damage (Troponin-I, CK-MB) comparing the cardioplegic solution in question to others that were renowned [ 90 , 91 , 92 , 93 ].…”