Clinical assessment of prolonged myocardial preservation for patients with a severely dilated heart.
BACKGROUND
The purpose of this study was to compare the myocardial protective effect of histidine-tryptophan-potassium and glucose-insulin-potassium cardioplegic solutions in patients with a dilated heart (left ventricular diastolic diameter > 55 mm, left ventricular systolic diameter > 45 mm) associated with prolonged cross-clamp time (longer than 200 minutes).


METHODS
We selected 20 patients with dilated hearts due to severe aortic regurgitation. Glucose-insulin-potassium cardioplegia was used in 11 patients and histidine-tryptophan-potassium cardioplegia was used in 9 patients.


RESULTS
After operation, the cardiac index was significantly increased in the histidine-tryptophan-potassium group (p < 0.05). Postoperative percent fractional shortening was 13.4% +/- 3.1% in the glucose-insulin-potassium group and 23.6% +/- 2.6% in the histidine-tryptophan-potassium group (p < 0.05). Creatine kinase levels were significantly lower in the histidine-tryptophan-potassium group than that in the glucose-insulin-potassium group (p < 0.05). The incidence of ventricular arrhythmia (higher than Lown's grade 2) was lower in the histidine-tryptophan-potassium group.


CONCLUSIONS
These data support the superiority of the histidine-tryptophan-potassium method over the glucose-insulin-potassium method for protection of the dilated heart during prolonged ischemia in open heart operations.
Hachida
M
M
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Nonoyama
M
M
Bonkohara
Y
Y
Hanayama
N
N
Saitou
S
S
Maeda
T
T
Ohkado
A
A
Lu
H
H
Koyanagi
H
H
D001022:Aortic Valve Insufficiency / Q000150:complications; D002314:Cardioplegic Solutions / Q000494:pharmacology*; D003402:Creatine Kinase / Q000097:blood; D005947:Glucose / Q000494:pharmacology; D006321:Heart / Q000187:drug effects*; D006324:Heart Arrest, Induced; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000601:surgery*; D007328:Insulin / Q000494:pharmacology; D017202:Myocardial Ischemia; D011188:Potassium / Q000494:pharmacology; D013997:Time Factors
D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D003402:Creatine Kinase; D005947:Glucose; D011188:Potassium