Clinical impact of histidine-ketoglutarate-tryptophan (HTK) cardioplegic solution on the perioperative period in open heart surgery patients.
BACKGROUND
Ischemia-reperfusion injury during open heart surgery related to unsuccessful myocardial protection may increase morbidity or mortality. We analyze the clinical outcome after cardiac surgery with a cardioplegic solution based on intracellular components added with histidine-ketoglutarate-tryptophan.


METHODS
Thirty patients programmed for elective open heart surgery were randomized into two groups. In group I (n = 15), myocardial protection was carried out with Bretschenider solution (HTK), and in group II (n = 15) with conventional crystalloid cardioplegia. The incidence of arrhythmias, inotropic support requirement, and length-of-stay in the intensive care unit were evaluated.


RESULTS
During reperfusion, there was no difference in incidence of arrhythmias; however, in the postoperative period group I had a lower incidence of arrhythmias (p = 0.001). Inotropic support (p = 0.003) and length-of-stay in the intensive care unit (p = 0.037) were lower in group I. There were no deaths in either group.


CONCLUSIONS
It was concluded that myocardial protection with Bretschneider solution effectively decreases incidence of arrhythmias, inotropic support, and length-of-stay in the intensive care unit.
Careaga
G
G
División de Cirugía Cardiotorácica, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico. gcareaga3@aol.com
Salazar
D
D
Téllez
S
S
Sánchez
O
O
Borrayo
G
G
Argüero
R
R
D000241:Adenosine / Q000737:chemistry; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000737:chemistry; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D001639:Bicarbonates / Q000737:chemistry; D002122:Calcium Chloride / Q000737:chemistry; D002314:Cardioplegic Solutions / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D001026:Coronary Artery Bypass; D017558:Elective Surgical Procedures; D005260:Female; D005947:Glucose / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D005978:Glutathione / Q000737:chemistry; D006324:Heart Arrest, Induced / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007328:Insulin / Q000737:chemistry; D007902:Length of Stay; D008274:Magnesium / Q000737:chemistry; D008297:Male; D008353:Mannitol / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D019188:Organ Preservation Solutions; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011189:Potassium Chloride / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D011343:Procaine / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D011446:Prospective Studies; D011887:Raffinose / Q000737:chemistry; D012306:Risk; D012965:Sodium Chloride / Q000737:chemistry
D001639:Bicarbonates; C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D002316:Cardiotonic Agents; D007328:Insulin; D019188:Organ Preservation Solutions; C041711:St. Thomas' Hospital cardioplegic solution; C055206:University of Wisconsin-lactobionate solution; D008353:Mannitol; D012965:Sodium Chloride; D011343:Procaine; D000493:Allopurinol; D011189:Potassium Chloride; D005978:Glutathione; D008274:Magnesium; D005947:Glucose; D000241:Adenosine; D002122:Calcium Chloride; D011887:Raffinose