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Effect of HTK solution for myocardial preservation
M Hachida1, A Ookado, M Nonoyama
1Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical College, Japan.
The Journal of Cardiovascular Surgery
|June 1, 1996
Summary
The study found that HTK solution, containing ketoglutarate and tryptophan, effectively protected the heart during prolonged ischemia in open heart surgery. Both HTK and GIK solutions provided satisfactory cardioplegia, with HTK showing better preservation of myocardial tissue.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Biochemistry
Background:
- The conventional GIK (glucose-insulin-potassium) solution is widely used for cardioplegia during cardiac surgery.
- The HTK (Custodiol-HTK) solution is an alternative cardioplegic agent, but its efficacy with prolonged cross-clamping requires further investigation.
Purpose of the Study:
- To compare the efficacy of HTK solution versus GIK solution for cardioplegia in a continuous 120-minute cross-clamping method.
- To evaluate the protective roles of ketoglutarate and tryptophan within the HTK solution in preserving cardiac function after ischemia.
Main Methods:
- Experimental evaluation of HTK solution with and without ketoglutarate or tryptophan in a 6-hour cardiac preservation model.
- Clinical comparison of HTK solution (3L, 120-minute ischemia) and GIK solution (intermittent perfusion) in 54 open-heart operations.
Main Results:
- In experimental models, exclusion of ketoglutarate or tryptophan from HTK solution significantly impaired cardiac function and increased enzyme release.
- Clinically, both HTK and GIK groups showed satisfactory cardioplegia, with no significant differences in percent fraction shortening or cardiac index.
- The GIK group exhibited higher postoperative levels of CK-MB and HBDH, and histological examination revealed myocardial and mitochondrial damage.
Conclusions:
- Ketoglutarate and tryptophan are crucial components of HTK solution for effective myocardial protection during ischemia.
- HTK solution is a viable alternative to GIK solution, enabling prolonged cross-clamping intervals with satisfactory cardiac preservation and potentially reduced myocardial injury.