title: The myocardial protection of HTK cardioplegic solution on the long-term ischemic period in pediatric heart surgery.
abstract: Cardioplegic reperfusion during a long term ischemic period interrupts cardiac surgery and also increase cellular edema due to repeated administration. We reviewed the clinical experiences on myocardial protection of one single perfusion with histidine-ketoglutarate-tryptophan (HTK) for infants. This retrospective study included 118 infants who underwent open-heart surgery between January 2004 and December 2007. We divided the entire cohort into two groups: In group H (n = 63), myocardial protection was carried out with one single perfusion with HTK solution, and in group S (n = 55) with conventional St. Thomas crystalloid cardioplegia. The duration of cardiopulmonary bypass (CPB) did not differ between these two groups, but the duration of aortic cross-clamping time in group H was significantly shorter than that in group S (p < 0.05). During reperfusion, the spontaneous re-beating rate was higher in group H (p < 0.05). There were no differences in doses of inotropic agent and creatinekinase (CK) values on postoperative day 1 between these two groups, but the level of CK in group H was significantly less than that in group S on postoperative day 2 (p < 0.01). The mortality in group H was lower than in group S (p < 0.05). The HTK group had shorter cross-clamping time and more frequent spontaneous defibrillation than St. Thomas group. We propose that HTK is valid for some complicated cardiac surgeries with long term cross-clamping time.
authors.affiliation: Department of Cardiopulmonary bypass, Cardiovascular Institute & Fuwai Heart Hospital, PUMC & CAMS, Beijing, People's Republic of China.
authors.forename: Jinping
authors.initials: J
authors.lastname: Liu
authors.forename: Zhengyi
authors.initials: Z
authors.lastname: Feng
authors.forename: Ju
authors.initials: J
authors.lastname: Zhao
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.forename: Cun
authors.initials: C
authors.lastname: Long
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002314:Cardioplegic Solutions / Q000737:chemistry / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D002675:Child, Preschool; D015331:Cohort Studies; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006639:Histidine / Q000737:chemistry; D006801:Humans; D007223:Infant; D007656:Ketoglutaric Acids / Q000737:chemistry; D008297:Male; D017202:Myocardial Ischemia / Q000188:drug therapy*; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D010477:Perfusion / Q000379:methods; D012189:Retrospective Studies; D014364:Tryptophan / Q000737:chemistry
chemical_list: D002314:Cardioplegic Solutions; D007656:Ketoglutaric Acids; D006639:Histidine; D014364:Tryptophan; D003402:Creatine Kinase