title: Histidine-tryptophan-ketoglutarate solution decreases mortality and morbidity in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease: an 11-year experience from a single institution.
abstract: Cardioplegic reperfusion during a long term ischemic period interrupts cardiac surgery and also increases cellular edema due to repeated solution administration. We reviewed the clinical experiences on myocardial protection of a single perfusion with histidine-tryptophan-ketoglutarate (HTK) for high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease. This retrospective study included 101 high-risk patients undergoing arterial switch operation between March 2001 and July 2012. We divided the cohort into two groups: HTK group, myocardial protection was carried out with one single perfusion with HTK solution; and St group, myocardial protection with conventional St. Thomas' crystalloid cardioplegic solution. The duration of cardiopulmonary bypass did not differ between the two groups. The mortality, morbidity, ICU stay, post-operative hospitalization time, and number of transfusions in HTK group were lower than those in St group (P<0.05). Univariate and multivariate analysis showed that HTK is a statistically significant independent predictor of decreased early mortality and morbidity (P<0.05). In conclusion, HTK solution seems to be an effective and safe alternative to St. Thomas' solution for cardioplegic reperfusion in high-risk patients with complex congenital heart disease.
authors.affiliation: Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China.
authors.forename: X W
authors.initials: XW
authors.lastname: Li
authors.affiliation: Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China.
authors.forename: Y Z
authors.initials: YZ
authors.lastname: Lin
authors.affiliation: Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China.
authors.forename: H
authors.initials: H
authors.lastname: Lin
authors.affiliation: Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China.
authors.forename: J B
authors.initials: JB
authors.lastname: Huang
authors.affiliation: Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China.
authors.forename: X M
authors.initials: XM
authors.lastname: Tang
authors.affiliation: Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China.
authors.forename: X M
authors.initials: XM
authors.lastname: Long
authors.affiliation: Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China.
authors.forename: W J
authors.initials: WJ
authors.lastname: Lu
authors.affiliation: Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China.
authors.forename: Z K
authors.initials: ZK
authors.lastname: Wen
authors.affiliation: Ruikang Hospital, Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China.
authors.forename: J
authors.initials: J
authors.lastname: Liang
authors.affiliation: Chinese Academy of Medical Sciences and Peking Union Medical College, Pediatric Center of Cardiac Surgery, Cardiovascular Institute and Fuwai Hospital, Beijing, China.
authors.forename: D Y
authors.initials: DY
authors.lastname: Li
authors.affiliation: Ruikang Hospital, Department of Cardiothoracic Surgery, Guangxi University, Nanning, Guangxi, China.
authors.forename: X F
authors.initials: XF
authors.lastname: Zhao
mesh_terms: D000704:Analysis of Variance; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006324:Heart Arrest, Induced / Q000379:methods*; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007552:Isotonic Solutions / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D010477:Perfusion / Q000379:methods; D011189:Potassium Chloride / Q000627:therapeutic use; D011343:Procaine / Q000627:therapeutic use; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D007552:Isotonic Solutions; C499108:Thomas' solution; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose