Myocardial protection using HTK solution in minimally invasive mitral valve surgery.
BACKGROUND
Minimally invasive cardiac surgery (MICS) is a safe and satisfactory approach used mainly in mitral valve surgery with excellent results in many centers. Cardioplegia administration can be still a problem, especially when an endoaortic clamp is used. We retrospectively analyzed our early results with histidine-triptophane-ketoglutarate (HTK) solution used for myocardial protection in MICS.


METHODS
Between February 2003 and February 2004, 8 patients underwent mitral valve surgery using an endo- cardiopulmonary bypass (CPB) system and HTK solution as myocardial protection. The mean patient age was 67.7 +/- 9.2 years, and the preoperative ejection fraction was normal in all patients. Three patients had valve repair and 5 had valve replacement. Mean CPB time was 129.2 +/- 19.4 minutes, and aortic cross-clamp duration was 88.5 +/- 15.4 minutes.


RESULTS
In every case HTK solution was used for only a single dose for cardioplegia at the beginning of the procedure, without any recalls. The heart restarted spontaneously at reperfusion in 6 of 8 cases (75%), and there were no significant modifications in electrocardiogram results or myocardial cytonecrosis enzymes (creatine kinase and its MB fraction) during the postoperative period.


CONCLUSIONS
HTK solution is a cold crystalloid cardioplegia solution that has demonstrated its utility in MICS because it provides a safe long cardioplegic arrest time and it reduces the risk of inadequate coronary perfusion due to dislodgement of the endoaortic clamp.
Savini
C
C
Department of Cardiovascular Surgery, Ospedale S.Orsola-Malpighi, University of Bologna, Italy. c_savini@yahoo.com
Camurri
N
N
Castelli
A
A
Dell'Amore
A
A
Pacini
D
D
Suarez
S Martin
SM
Grillone
G
G
Di Bartolomeo
R
R
D000368:Aged; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D003250:Constriction; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006349:Heart Valve Diseases / Q000201:enzymology / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D011189:Potassium Chloride / Q000627:therapeutic use; D011343:Procaine / Q000627:therapeutic use; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors
C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D005947:Glucose