One single dose of histidine–tryptophan–ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repetitive cold blood cardioplegia: A prospective randomized study

Braathen, Bjørn; Jeppsson, Anders; Scherstén, Henrik; Hagen, Ole Magnus; Vengen, Ø.A.; Rexius, Helena; Lepore, Vincenzo; Tønnessen, Theis

doi:10.1016/j.jtcvs.2010.07.011

Cited by 96 publications

(83 citation statements)

References 26 publications

(30 reference statements)

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“…Mortality and morbidity rates for high-risk patients with complex congenital heart disease are relatively high; therefore, although it remains difficult, the optimal myocardial protection strategy for high-risk patients should be urgently determined (6,18). Data collected from instances in which HTK solution has been used for high-risk patients with complex congenital heart disease remains rare (19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

“…Histidine has a buffer effect and may enhance the efficiency of anaerobic glycolysis, tryptophane stabilizes the cell membrane and the addition of mannitol decreases cellular oedema, whereas ketoglutarate is a precursor of nicotinamide adenine dinucleotide (6). Several studies have demonstrated the efficacy of the HTK solution based on biochemical markers or physiological evaluation in experimental models (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…In order to improve myocardial protection during AVR for AS, a number of studies have been conducted including those seeking ideal routes of cardioplegic solution delivery or types of cardioplegic solution, and those determining factors related to PMI [8–15]. These studies, however, are limited by experimental study designs and have shown mixed results.…”

Section: Introductionmentioning

confidence: 99%

Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes

Lee

Kim

et al. 2014

Korean J Thorac Cardiovasc Surg

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BackgroundAs hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS).MethodsConsecutive 314 patients (mean age, 62.5±10.8 years; 143 females) with severe AS undergoing isolated AVR were included. Postoperative myocardial injury (PMI) was defined as 1) maximum postoperative creatinine kinase isoenzyme MB or troponin-I levels ≥10 times of reference, 2) postoperative low cardiac output syndrome or episodes of ventricular arrhythmia, or 3) left ventricular ejection fraction of less than 55% and decrease in left ventricle (LV) ejection fraction of more than 20% of the baseline value.ResultsThere were 90 patients (28.7%) who developed PMI. There were five cases of early death (1.6%), all of whom had PMI. On multivariable analysis, the use of histidine-tryptophan-ketoglutarate (HTK) solution instead of blood cardioplegia (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.63 to 5.77; p=0.001), greater LV mass (OR, 1.04; 95% CI, 1.01 to 1.07; p=0.007), and increased cardiac ischemic time (OR, 1.13; 95% CI, 1.05 to 1.22; p<0.001) were independent predictors for PMI. Patients who had PMI showed significantly inferior long-term survival than those without PMI (p=0.049).ConclusionPMI occurred in a considerable proportion of patients undergoing AVR for severe AS and was associated with poor long-term survival. HTK cardioplegia, higher LV mass, and longer cardiac ischemic duration were suggested as predictors of myocardial injury.

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“…Although more spontaneous ventricular fibrillation after aortic unclamping had been found in adult patients receiving HTK cardioplegia, one single dose of cold HTK gives equally good myocardial protection in cardiac surgery as multidose cold blood cardioplegia (CBC). [3][4][5] Experimental studies have shown, however, that HTK solution provides inadequate cardioprotection when compared to CBC. 6,7 The relative advantage of blood cardioplegia in relation to crystalloid cardioplegia is still the subject of debate in pediatric cardiac surgery.…”

mentioning

confidence: 99%

“…Moreover, the safety of HTK used for prolonged ischemic time (over 75 minutes) has not been documented. 3,6,7 Our previous study showed that HTK solution results in less spontaneous ventricular fibrillation and lower mortality when compared to St. Thomas solution, and HTK is valid for complex congenital cardiac surgery with a prolonged cross-clamping time (105-242 minute). 11 Therefore, we wanted to compare the effect of cold HTK with that of CBC, which was assumed to be the best cardioplegia method, on a neonatal piglet model.…”

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confidence: 99%

Which Is the Better Option During Neonatal Cardiopulmonary Bypass

Chen

Liu

et al. 2013

ASAIO Journal

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The optimal myocardial protection strategy for newborns/infants undergoing congenital heart surgery remains controversial. The purpose of this study was to compare myocardial protection using histidine-tryptophan-ketoglutarate (HTK) and cold blood cardioplegia in a neonatal piglet model. Twenty-one piglets were randomized to three groups: the control group (C group, n = 7), a single dose of HTK group (H group, n = 7), and multidose cold blood cardioplegia group (B group, n = 7). Animals in the two experimental groups were placed on hypothermic cardiopulmonary bypass, after which the ascending aorta was clamped for 2 hours. Immediately after declamping, both the difference between arterial and coronary sinus blood lactate concentrations and the oxygen extraction did not differ between the H group and the B group. At 3 hours after declamping, rise in serum troponin-T and creatine kinase isoenzyme MB levels showed no significant differences between the H group and the B group (p = 0.735 and p = 0.103, respectively). No significant differences were noted in the myocardial lactate content, ATP content, and histopathological score between the H group and the B group (p = 0.810, p = 0.158, and p = 0.399, respectively). Transfusion requirement in the B group was significantly more than that in the H group (p = 0.003). HTK solution provides equivalent myocardial protection to multidose cold blood cardioplegia for the neonatal heart with less transfusion requirement.

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One single dose of histidine–tryptophan–ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repetitive cold blood cardioplegia: A prospective randomized study

Abstract: One single dose of antegrade cold HTK cardioplegic solution in elective mitral valve surgery protects the myocardium equally well as repetitive antegrade cold blood cardioplegia.

Cited by 96 publications

References 26 publications

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

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

Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes

Which Is the Better Option During Neonatal Cardiopulmonary Bypass

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