The Comparison of the Effects of Bretschneider's Histidine‐Tryptophan‐Ketoglutarate and Conventional Crystalloid Cardioplegia on Pediatric Myocardium at Tissue Level

Abstract

Cardioplegic arrest is one of the most common myocardial protection strategies. A wide variety of cardioplegic solutions are routinely being used. There is an ongoing discussion about the relative effectiveness of these solutions considering myocardial protection. This study aims to investigate the hypothesis that the use of histidine-tryptophan-ketoglutarate (HTK) cardioplegia leads to decreased ischemic damage on myocardium compared with the use of conventional crystalloid cardioplegia. The study population was 32 patients operated on at Başkent University, Department of Cardiovascular Surgery for congenital heart diseases. The first group of 16 patients received conventional crystalloid cardioplegia (KK group) which is a modification of St. Thomas' solution, while the second group of 16 patients received HTK solution (HTK group). The echocardiographic measurements and the laboratory values of the patients were taken as the clinical variables. Right ventricular biopsies were taken from every patient before and after cardioplegic arrest. These biopsies were histopathologically examined for apoptosis using caspase-3 antigen and cell proliferation using Ki-67 antigen. The statistical analysis revealed no significant difference between the two groups regarding the clinical variables, apoptotic indices and proliferation indices. The apoptotic indices in the postcardioplegic arrest biopsies positively correlated with aortic clamp time in the KK group but not in the HTK group. Liver function tests on postoperative day 1 positively correlated with aortic clamp time in both groups. On postoperative day 2, this correlation was sustained in the KK group and ceased in HTK group. The difference in the correlation of apoptotic indices and liver function tests between the groups is accepted as a supportive finding for HTK solution. However, it can be postulated that when the aortic clamp times are similar to those in the present study, the clinical manifestation of the difference between the two solutions would not be significant.

Clinical Assessment of Histidine‐Tryptophan‐Ketoglutarate Solution and Modified St. Thomas' Solution in Pediatric Cardiac Surgery of Tetralogy of Fallot

“…In this study, no other differences in postoperative values across the two groups could be demonstrated on clinical levels. This result was similar to Korun's study which found no clinically or histopathologically detectable difference between the two solutions (18). In Korun's study the mean ACC time was about 70 min and about 80 min in the present study.…”

Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution

“…Data collected from instances in which HTK solution has been used for high-risk patients with complex congenital heart disease remains rare (19)(20)(21)(22). A study of Fuwai Hospital compared the myocardial protective effect induced by HTK solution and conventional St. Thomas crystalloid cardioplegia on the long-term ischemic period (cross-clamping time, >90 min) during severe complex pediatric cardiac surgery without pulmonary arterial hypertension.…”

Histidine and other amino acids in blood and urine after administration of Bretschneider solution (HTK) for cardioplegic arrest in patients: effects on N-metabolism

“…Bretschneider (histidine-tryptophan-ketoglutarate, HTK) solution is routinely administered for cardioplegic arrest in many countries (Careaga et al 2001 ). In clinical studies as well as in experimental models the Bretschneider solution has been shown to achieve a better myocardial protection during ischemia as compared to pure electrolyte-containing crystalloid cardioplegic solutions without histidine or to blood cardioplegia (Beyersdorf et al 1990 ; Careaga et al 2001 ; Kober et al 1998 ; Korun et al 2013 ; Sakata et al 1998 ; Scrascia et al 2011 ). The effectiveness of the solution becomes apparent in an increased cardiac output, fewer arrhythmias, more frequent spontaneous defibrillation as well as decreasing length of stay in the intensive care unit (Careaga et al 2001 ; Sakata et al 1998 ).…”