One single dose of histidine-tryptophan-ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repetitive cold blood cardioplegia: a prospective randomized study.
OBJECTIVE
Histidine-tryptophan-ketoglutarate (HTK-Custodiol) cardioplegic solution is administered as one single dose for more than 2 hours of ischemia. No prospective randomized clinical study has compared the effects of HTK and cold blood cardioplegia on myocardial damage in elective mitral valve surgery. Thus, the main aim of the present study was to examine whether one single dose of cold antegrade HTK gives as good myocardial protection as repetitive antegrade cold blood cardioplegia in mitral valve surgery.


METHODS
Eighty consecutive patients undergoing elective isolated mitral valve surgery for mitral regurgitation, with or without ablation for atrial fibrillation, were included in the study and randomized to HTK or blood cardioplegia. Markers of myocardial injury (troponin-T and creatine kinase MB) were analyzed at baseline and 7 hours, 1 day, 2 days, and 3 days after surgery.


RESULTS
No significant difference in creatine kinase MB and troponin-T between HTK and blood cardioplegia groups was found at any time point. There was a significant correlation between ischemic time and markers of myocardial injury in the HTK group only and significantly more spontaneous ventricular fibrillation after release of crossclamping in the HTK group.


CONCLUSIONS
One single dose of antegrade cold HTK cardioplegic solution in elective mitral valve surgery protects the myocardium equally well as repetitive antegrade cold blood cardioplegia.
Braathen
Bjørn
B
Department of Cardiothoracic Surgery, Oslo University Hospital Ullevål, Oslo, Norway.
Jeppsson
Anders
A
Scherstén
Henrik
H
Hagen
Ole M
OM
Vengen
Øystein
Ø
Rexius
Helena
H
Lepore
Vincenzo
V
Tønnessen
Theis
T
D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D052279:Creatine Kinase, MB Form / Q000097:blood; D017558:Elective Surgical Procedures; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced; D016014:Linear Models; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D009664:Norway; D011189:Potassium Chloride / Q000008:administration & dosage; D011343:Procaine / Q000008:administration & dosage; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D020107:Troponin T; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D052279:Creatine Kinase, MB Form; D005947:Glucose