Clinical Assessment of Prolonged Myocardial Preservation for Patients With a Severely Dilated Heart

Hachida, M; Nonoyama, M; Bonkohara, Yukihiro; Hanayama, Naoji; Saitou, Satoshi; Maeda, Takeshi; Ohkado, Akihiko; Liu, Hua; Koyanagi, Hitoshi

doi:10.1016/s0003-4975(97)82821-4

Cited by 18 publications

(9 citation statements)

References 19 publications

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“…The included histidine is thought to have a buffer effect associated with enhanced efficiency of anaerobic glycolysis; tryptophan and mannitol are proposed to function as cell membrane stabilizers and as reducing agents to prevent the formation of cellular edema; whereas 2-ketoglutarate is an intermediate of the tricarboxylic acid (TCA) cycle and a precursor of nicotinamide adenine dinucleotide which is assumed to serve in energy production [ 36 ]. Several studies have demonstrated the efficacy of HTK solution in preserving myocardial adenosine triphosphate stores, improving post-arrest contractile function and minimizing myocardial necrosis [ 38 , 39 ]. Careaga and colleagues [ 40 ] reported that patients receiving cardioplegia with HTK solution had a decreased incidence of postoperative arrhythmias, length-of-stay in the intensive care unit, and inotropic support; while Lin and colleagues [ 41 ] have shown that blood transfusions, mortality, morbidity, and hospital readmission were significantly lower compared to those receiving another extracellular based cardiologic solution (St. Thomas’ Hospital solution, 144 mEq Na + , 20 mEq K + , 32 mEq Mg ++ , and 4.8 mEq Ca ++ per liter solution, pH 5.5).…”

Section: Introductionmentioning

confidence: 99%

Lung Protection Strategies during Cardiopulmonary Bypass Affect the Composition of Blood Electrolytes and Metabolites—A Randomized Controlled Trial

Buggeskov

Maltesen

Rasmussen

et al. 2018

JCM

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Cardiac surgery with cardiopulmonary bypass (CPB) causes an acute lung ischemia-reperfusion injury, which can develop to pulmonary dysfunction postoperatively. This sub-study of the Pulmonary Protection Trial aimed to elucidate changes in arterial blood gas analyses, inflammatory protein interleukin-6, and metabolites of 90 chronic obstructive pulmonary disease patients following two lung protective regimens of pulmonary artery perfusion with either hypothermic histidine-tryptophan-ketoglutarate (HTK) solution or normothermic oxygenated blood during CPB, compared to the standard CPB with no pulmonary perfusion. Blood was collected at six time points before, during, and up to 20 h post-CPB. Blood gas analysis, enzyme-linked immunosorbent assay, and nuclear magnetic resonance spectroscopy were used, and multivariate and univariate statistical analyses were performed. All patients had decreased gas exchange, augmented inflammation, and metabolite alteration during and after CPB. While no difference was observed between patients receiving oxygenated blood and standard CPB, patients receiving HTK solution had an excess of metabolites involved in energy production and detoxification of reactive oxygen species. Also, patients receiving HTK suffered a transient isotonic hyponatremia that resolved within 20 h post-CPB. Additional studies are needed to further elucidate how to diminish lung ischemia-reperfusion injury during CPB, and thereby, reduce the risk of developing severe postoperative pulmonary dysfunction.

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Section: Introductionmentioning

confidence: 99%

Lung Protection Strategies during Cardiopulmonary Bypass Affect the Composition of Blood Electrolytes and Metabolites—A Randomized Controlled Trial

Buggeskov

Maltesen

Rasmussen

et al. 2018

JCM

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“…Several studies have demonstrated the efficacy of the HTK solution based on biochemical markers or physiological evaluation in experimental models (7)(8)(9). HTK solution helps to preserve myocardial adenosine triphosphate stores, improve post-arrest contractile function and minimize myocardial necrosis (10,11). HTK solution has also been shown to preserve the coronary artery endothelium, which may help to improve functional cardiac recovery (12,13).…”

Section: Introductionmentioning

confidence: 99%

Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution

Lin

Xiang-wei

Tang

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Cardioplegic reperfusion during a long-term ischemic period interrupts cardiac surgery and increases cellular edema due to repeated administration. The present clinical study compared the protective effects of histidine-ketoglutarate-tryptophan (HTK) solution and St. Thomas crystalloid cardioplegia. Clinical experiences of the myocardial protection induced by one single perfusion with HTK were reviewed in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease. This retrospective study included 88 high-risk patients (aortic cross-clamp time, >120 min) between March 2001 and July 2012. The cohort was divided into two groups according to the technique used. Either myocardial protection was performed with one single perfusion with HTK solution (HTK group) or with conventional St. Thomas crystalloid cardioplegia (St group). The duration of cardiopulmonary bypass did not differ between the two groups. The mortality, morbidity, intensive care unit (ICU) stay, postoperative hospitalization, and transfusions of HTK group are significantly lower than those of the St group (P<0.05). Univariate and multivariate analysis demonstrated that HTK is a statistically significant independent predictor of decreased early mortality and morbidity (P<0.05). In conclusion, the present findings suggested that HTK solution decreases mortality, morbidity, ICU stay, postoperative hospitalization, and transfusions in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease.

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“…Similarly, Hachida et al (Hachida M, 1997) demonstrated that the promotion of anaerobic glycolysis during ischemia by HTK solution results in superior preservation of the contractile function of the heart.…”

Section: Discussionmentioning

confidence: 92%

Clinical Impact of Custodiol Cardioplegic Solution on Patients Undergoing Complex Cardiac Surgery With Mild to Moderate Impairment of Left Ventricular Systolic Function

Ramadan¹,

Abdelgawad

2017

ESJ

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Background: The Bretschneider HTK solution is used widely for multiorgan preservation for transplantation, as well as a cardioplegic agent that allows single dose administration which is an attractive option for lengthy complex cardiac surgery. It was proved that it is simple to use, safe and practical. Moreover, it is considered to confer sufficient myocardial protection for more than 2 h of cardiac arrest. We undertook this descriptive study to analyze the performance of HTK solution in patients undergoing complex cardiac surgery with mild to moderate impairment of left ventricular systolic function. Patients and methods: A total of 50 patients underwent different complex cardiac surgery at national heart institute from January 2015 to November 2016 using single dose Custodiol cardioplegia as the primary and sole cardioplegic agent, their data was prospectively collected and their hospital outcome was analyzed as regards to ten study endpoints namely Prolonged ventilation, return to theatre for bleeding, renal failure, stroke, 30 days mortality, postoperative MI, need for inotropes, time on inotropes, ICU stay and hospital stay. Pre- and postoperative echocardiography was done to compare and evaluate the change of LV function using the parameters of End Systolic Dimension, End Diastolic Dimension, Fraction Shortening and Ejection Fraction of the left ventricle. Results: Half of the patients were males. Their age ranged between 16 – 65 years with a mean (standard deviation) of 47.46(11.10). preoperative ejection fraction ranged from 30 % to 49% with a mean (standard deviation) of 41.8 (6.32), the majority of them (64%) had NYHA class of 3 and half of them had CCS of 3. all patients were done electively. The most common procedure done was redo DVR 24% (12 patients) followed by Bentall operation 22%(11 patients). This is followed by CABG + MVR 7 patients (14%), then an equal number of 6 patients (12%) who underwent redo MVR post-infective endocarditis and CABG+ MVrep. The repair of tricuspid valve was done for 14 patients (28%) either with MVR or DVR. 4 patients (8%) had CABG +AVR for their combined lesions and another equal number of two patients (4%) underwent redo CABG and AVR + conduit (valve separate tube graft operation). prolonged ventilation occurred in 20% of the cases. An equal percentage of 6% of the patients had to return to the operative room and had postoperative MI. Renal failure occurred in 4% of the patients and as far as 30-day mortality is concerned, a similar 4% of patients died within this period. EF and FS were very similar when compared together (41.8 ± 6.32 %, 20.8 ± 2.35 % preoperatively compared to 41.92 ± 7.49%, 20.85 ± 3.25% postoperatively). P value was insignificant (0.937 and 0.929) respectively. Conclusion: A single dose of an HTK cardioplegic solution provides good myocardial protection in complex cardiac surgery with mild to moderate impairment of LV function and has a good immediate postoperative outcome.

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Clinical Assessment of Prolonged Myocardial Preservation for Patients With a Severely Dilated Heart

Cited by 18 publications

References 19 publications

Lung Protection Strategies during Cardiopulmonary Bypass Affect the Composition of Blood Electrolytes and Metabolites—A Randomized Controlled Trial

Lung Protection Strategies during Cardiopulmonary Bypass Affect the Composition of Blood Electrolytes and Metabolites—A Randomized Controlled Trial

Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution

Clinical Impact of Custodiol Cardioplegic Solution on Patients Undergoing Complex Cardiac Surgery With Mild to Moderate Impairment of Left Ventricular Systolic Function

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