title: Which is the better option during neonatal cardiopulmonary bypass: HTK solution or cold blood cardioplegia?
abstract: The optimal myocardial protection strategy for newborns/infants undergoing congenital heart surgery remains controversial. The purpose of this study was to compare myocardial protection using histidine-tryptophan-ketoglutarate (HTK) and cold blood cardioplegia in a neonatal piglet model. Twenty-one piglets were randomized to three groups: the control group (C group, n = 7), a single dose of HTK group (H group, n = 7), and multidose cold blood cardioplegia group (B group, n = 7). Animals in the two experimental groups were placed on hypothermic cardiopulmonary bypass, after which the ascending aorta was clamped for 2 hours. Immediately after declamping, both the difference between arterial and coronary sinus blood lactate concentrations and the oxygen extraction did not differ between the H group and the B group. At 3 hours after declamping, rise in serum troponin-T and creatine kinase isoenzyme MB levels showed no significant differences between the H group and the B group (p = 0.735 and p = 0.103, respectively). No significant differences were noted in the myocardial lactate content, ATP content, and histopathological score between the H group and the B group (p = 0.810, p = 0.158, and p = 0.399, respectively). Transfusion requirement in the B group was significantly more than that in the H group (p = 0.003). HTK solution provides equivalent myocardial protection to multidose cold blood cardioplegia for the neonatal heart with less transfusion requirement.
authors.affiliation: Department of Cardiopulmonary Bypass, Fuwai Hospital & National Center for Cardiovascular Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.forename: Jinping
authors.initials: J
authors.lastname: Liu
authors.forename: Shoujun
authors.initials: S
authors.lastname: Li
authors.forename: Wenlei
authors.initials: W
authors.lastname: Li
authors.forename: Fuxia
authors.initials: F
authors.lastname: Yan
authors.forename: Peng
authors.initials: P
authors.lastname: Sun
authors.forename: Huiying
authors.initials: H
authors.lastname: Wang
authors.forename: Cun
authors.initials: C
authors.lastname: Long
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism; D000818:Animals; D000831:Animals, Newborn; D001769:Blood; D002314:Cardioplegic Solutions; D003080:Cold Temperature; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D052279:Creatine Kinase, MB Form / Q000097:blood; D005947:Glucose; D006324:Heart Arrest, Induced / Q000379:methods*; D019344:Lactic Acid / Q000097:blood / Q000378:metabolism; D008353:Mannitol; D023421:Models, Animal; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D010100:Oxygen / Q000097:blood; D011189:Potassium Chloride; D011343:Procaine; D034421:Sus scrofa; D020107:Troponin T / Q000097:blood
chemical_list: C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D020107:Troponin T; D019344:Lactic Acid; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D000255:Adenosine Triphosphate; D052279:Creatine Kinase, MB Form; D005947:Glucose; D010100:Oxygen