Myocardial protection with histidine-tryptophan-ketoglutarate solution in comparison with hypothermic hyperkalemic blood solution in the correction of acyanotic congenital heart diseases

Background Intraoperative myocardial preservation is essential in pediatric cardiac surgeries. The combination of hypothermia and hyperkalemic cardioplegia is commonly used. Histidine-tryptophan-ketoglutarate (HTK–Custodiol) is a long-acting crystalloid cardioplegia which induces cardiac arrest by r...

Full description

Saved in:
Bibliographic Details
Published in:Ain-Shams journal of anesthesiology 2022-09, Vol.14 (1), p.1-9, Article 61
Main Authors: Ali, Ahmed M., Seif Elnasr, Gihan, Kamal, Manal M., Aboseif, Eman M., Abdel Twab, Samar M.
Format: Article
Language:English
Subjects:
Adenosine triphosphate
Anesthesiology
Cardioplegia
Cold
Congenital diseases
Critical Care Medicine
Heart surgery
Hypothermia
Intensive
Intensive care
Ischemia
Length of stay
Medicine
Medicine & Public Health
Myocardial preservation
Original Article
Pediatrics
Potassium
Surgery
Vasoactive inotropic score
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Intraoperative myocardial preservation is essential in pediatric cardiac surgeries. The combination of hypothermia and hyperkalemic cardioplegia is commonly used. Histidine-tryptophan-ketoglutarate (HTK–Custodiol) is a long-acting crystalloid cardioplegia which induces cardiac arrest by reducing the extracellular sodium concentration. Cold blood cardioplegia has many modifications differing in the blood: crystalloid ratio, buffers, substrates, and final potassium concentration which induces cardiac arrest in diastole as the main role. We compared cold histidine-tryptophan-ketoglutarate crystalloid (HTK) solution with hypothermic hyperkalemic blood (HHB) cardioplegia solution regarding their efficacy in myocardial preservation in patients undergoing total repair of non-cyanotic congenital cardiac defects. We assessed postoperative cardiac troponin level, myocardial function, inotropic support, intensive care unit (ICU) length of stay, hospital length of stay, and the incidence of prolonged postoperative mechanical ventilation as indicators of myocardial protection. Results This interventional, single-blinded, randomized, comparative, and prospective clinical study was conducted randomly on 60 patients, aged between 6 and 24 months undergoing total surgical repair. We found no statistically significant difference regarding patients’ personal, demographics, and operative details (surgery duration, cardiopulmonary bypass time, aorta clamp time). However, patients who were given HTK cardioplegia were found to stay less in the ICU (with a p value
ISSN:2090-925X
1687-7934
2090-925X
DOI:10.1186/s42077-022-00260-z