Which Is the Better Option During Neonatal Cardiopulmonary Bypass

Abstract

The optimal myocardial protection strategy for newborns/infants undergoing congenital heart surgery remains controversial. The purpose of this study was to compare myocardial protection using histidine-tryptophan-ketoglutarate (HTK) and cold blood cardioplegia in a neonatal piglet model. Twenty-one piglets were randomized to three groups: the control group (C group, n = 7), a single dose of HTK group (H group, n = 7), and multidose cold blood cardioplegia group (B group, n = 7). Animals in the two experimental groups were placed on hypothermic cardiopulmonary bypass, after which the ascending aorta was clamped for 2 hours. Immediately after declamping, both the difference between arterial and coronary sinus blood lactate concentrations and the oxygen extraction did not differ between the H group and the B group. At 3 hours after declamping, rise in serum troponin-T and creatine kinase isoenzyme MB levels showed no significant differences between the H group and the B group (p = 0.735 and p = 0.103, respectively). No significant differences were noted in the myocardial lactate content, ATP content, and histopathological score between the H group and the B group (p = 0.810, p = 0.158, and p = 0.399, respectively). Transfusion requirement in the B group was significantly more than that in the H group (p = 0.003). HTK solution provides equivalent myocardial protection to multidose cold blood cardioplegia for the neonatal heart with less transfusion requirement.

Comparison between the Effects of Bretschneider’s HTK Solution and Cold Blood Cardioplegia on Systemic Endothelial Functions in Patients who Undergo Coronary Artery Bypass Surgery: a Prospective Randomized and Controlled Trial

“…While histidine, which is present in the HTK solution, increases anaerobic glycolysis, tryptophan stabilizes the cell membrane, and mannitol decreases cellular edema. Histidine, a buffer with protein structure, has properties superior to bicarbonate in terms of balancing the intracellular pH and preservation of adenosine triphosphate store [ 14 , 15 ] .…”

Custodiol cardioplegia solution compared to cold blood cardioplegia in pediatric cardiac surgery: a single-institution experience

“…Our finding that single dose of HTK is safe for preservation of the myocardium in pediatric patients is supported by other studies examining post-ischemic cardiac function at the cellular and organ level. [9][10][11][12][13] HTK has been used extensively in heart preservation during procurement as well as during cardiotomy with clamp times of 150 minutes reported. [14][15][16] Extended myocardial ischemia of 223 minutes that was well tolerated with preserved ventricular function has been reported in unpublished perfusion listserv surveys.…”

Lung Protection Strategies during Cardiopulmonary Bypass Affect the Composition of Blood Electrolytes and Metabolites—A Randomized Controlled Trial

“…The hypothermic histidine-tryptophan-ketoglutarate (HTK) solution is an extracellular based preservation solution used for organ (e.g., lung) transplantation [ 21 , 30 , 31 , 32 ], in addition to its use as a cardioplegic agent. Preservation with HTK-Custodiol (Koehler Chemi, GMBH, Germany), or its equivalent Bretschneider solution [ 33 , 34 , 35 ], is administered as a single dose and claimed to give organ protection for more than two hours [ 36 ]. The solution contains 15 mM Na + , 9 mM K + , 4 mM Mg ++ , 0.015 mM Ca ++ , 198 mM histidine, 2 mM tryptophan, 1 mM 2-ketoglutarate, and 30mM mannitol, with a pH of 7.02–7.2 at 25 °C (77 °F) [ 37 ].…”