A Prospective Clinical Trial of Histidine-Tryptophan-Ketoglutarate Solution in Congenital Heart Surgery

Lee, Cheul; Kim, Yong Jin

Abstract

BACKGROUND: There are still debates in the literature on the relative benefits of blood cardioplegia and crystalloid cardioplegia in pediatric cardiac surgery. We performed a clinical trial to compare the myocardial protective effect between HTK solution and blood cardioplegic solution in congenital heart surgery. MATERIAL AND METHOD: 15 patients who underwent HTK solution cardioplegia (group 1) and 15 patients who underwent blood cardioplegia (group 2) were included in this study. Preoperative and postoperative serial serum cardiac enzyme levels (troponin I, CK-MB, LDH) were measured in all patients. Clinical data were analyzed and compared between the two groups. RESULT: There were no differences in age and body weight between the two groups. Operative diagnosis included ventricular septal defect (VSD, n=4), atrial septal defect (ASD, n=1), tetralogy of Fallot (TOF, n=4), and other complex heart diseases (n=6) in group 1, VSD (n=7), ASD (n=5), and TOF (n=3) in group 2. Cardiopulmonary bypass times were 99.1+/-48.1 minutes in group 1, and 69.3+/-27.3 minutes in group 2 (p=0.02). Aortic clamping times were 52.1+/-23.6 minutes in group 1, and 37.9+/-20.5 minutes in group 2 (p=0.07). There was no mortality and spontaneous defibrillation was possible in all patients. No differences were observed in the serial enzyme levels between the two groups. There were no differences in the duration of inotropic support and ventilator time between the two groups.
CONCLUSION
HTK solution provided comparable myocardial protection compared with blood cardioplegic solution. A single high dose of HTK solution may be safely and conveniently used for an extended periods as well in congenital heart surgery.