Effect of HTK solution for myocardial preservation.
The aim of this study was to investigate the efficacy of HTK solution for cardioplegia in the continuous 120-minute cross-clamping method in comparison with the conventional GIK method. In an experimental model, the efficacy of ketoglutarate and tryptophan in recovering cardiac function after 6 hours' preservation was evaluated. In Group A, in which ketoglutarate was excluded from the HTK solution, percent developed pressure was significantly decreased (p<0.01) and the released enzyme (CK-MB) was significantly increased, but coronary flow was not significantly changed. In Group B, in which tryptophan was excluded from the HTK solution, a significant decrease in percent developed pressure and coronary flow was seen (p<0.01). This indicated that ketoglutarate and tryptophan were effective in protecting the myocardium during the ischemia. In the clinical study, 54 open heart operations were performed with cardioplegic solution, using either HTK solution or GIK solution. In the HTK Group, the heart was exposed to 120 minutes' of ischemia after the infusion of HTK solution (3L). In the GIK group, intermittent GIK perfusion was performed every 30 minutes in association with continuous cold blood perfusion. Percent fraction shortening and cardiac index were not significantly different. However, CK-MB and HBDH were increased in the GIK group, postoperatively. Histological findings showed deterioration of the mitochondria and myocytes during ischemia in the GIK group. These data suggest that the effect of the cardioplegias in heart preservation was satisfactory in both groups, although the interval of intermittent perfusion was prolonged to 120 minutes in the HTK solution.
Hachida
M
M
Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Ookado
A
A
Nonoyama
M
M
Koyanagi
H
H
D000818:Animals; D006348:Cardiac Surgical Procedures; D002314:Cardioplegic Solutions / Q000737:chemistry; D005947:Glucose / Q000737:chemistry; D006321:Heart / Q000187:drug effects; D006324:Heart Arrest, Induced / Q000379:methods*; D016027:Heart Transplantation; D006801:Humans; D007328:Insulin / Q000737:chemistry; D008353:Mannitol / Q000737:chemistry; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D009206:Myocardium / Q000737:chemistry / Q000648:ultrastructure; D009926:Organ Preservation / Q000379:methods*; D011188:Potassium / Q000737:chemistry; D011189:Potassium Chloride / Q000737:chemistry; D011343:Procaine / Q000737:chemistry; D051381:Rats; D011917:Rats, Inbred Lew; D013997:Time Factors
C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose; D011188:Potassium