HTK versus Blood Cardioplegia for Myocardial Protection in Patients with Complex Coronary Artery Disease and Left Ventricular Dysfunction: A Case Control Study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGRong ,  GAOChang-qing , XIAOCang-song , WUYang , WANGJia-li , LIJia-chun , LUOJin , ZHANGTao , MALan

Department of Cardiovascular Surgery, Peoples' Liberation Army General Hospital, Beijing 100853, P. R. China;

Corresponding author：

GAOChang-qing, Email: gaochq301@yahoo.com

Keywords：

Complex coronary artery disease; HTK solution; Blood cardioplegia; Myocardial protection; Left ventricular dysfunction

DOI：

10.7507/1007-4848.20160229

Video：

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Objective To retrospectively compare and analyze the effect of myocardial protection between histidinetryptophane-ketoglutarate (HTK) and 4:1 blood cardioplegia in patients with complex coronary artery disease and left ventricular dysfunction. Methods From January 2003 to July 2013, 2132 patients underwent isolated coronary artery bypass grafting (CABG) in our institution. Among them, 227 patients with complex coronary artery disease (left main or triple vessel disease) and left ventricular dysfunction (ejection fraction ≤ 50%) were included in this study. According to the category of cardioplegia utilized in the operations, the patients were divided into two groups: a HTK group (85 males and 4 females, n=89) and a blood cardioplegia group (113 males and 25 females, n=138). The average age was 62.78±9.30 years in the HTK group and 62.74±9.07 years in the blood cardioplegia group. The effect of myocardial protection between two groups was compared. Results According to the pre-operational data of these two groups, there was no significant difference identified in terms of basic characteristics and risk factors, even though more female patients were found in the blood cardiophegia group and more patients with renal dysfunction were found in the HTK group. In addition, the patients in the HTK group had more distal anastomosis, longer cardiopulmonary time and cross clamping time than those in the blood cardiophegia group. Based on the results measured by those primary assessment criteria,there was no significant difference being found between these two groups. However, on those secondary assessment criteria the pulmonary pressure and inotropic support after reperfusion were significantly higher in the HTK group than its counterpart. Conclusion For patients with complex coronary artery disease and left ventricular dysfunction, HTK solution and blood cardioplegia provide similar effective myocardial protection. HTK doesn't significantly increase postoperative adverse cardiovascular events under the circumstance of longer ischemic time.

Citation： WANG Rong, GAO Chang-qing, XIAO Cang-song, WU Yang, WANG Jia-li, LI Jia-chun, LUO Jin, ZHANG Tao, MA Lan. HTK versus Blood Cardioplegia for Myocardial Protection in Patients with Complex Coronary Artery Disease and Left Ventricular Dysfunction: A Case Control Study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(10): 954-959. doi: 10.7507/1007-4848.20160229 Copy

1.	王嵘,高长青,肖苍松, 等. 外科血运重建治疗缺血性心脏病左心功能不全的早期结果及危险因素分析. 中国胸心血管外科临床杂志, 2015, 22(10): 954-960.
2.	Guru V, Omura J, Alghamdi AA, et al. Is blood superior to crystalloid cardioplegia? A Meta-analysis of randomized clinical trials. Circulation, 2006, 114[Suppl I]: I-331-I-338.
3.	Sá MPBO, Rueda FG, Ferraz PE, et al. Is there any difference between blood and crystalloid cardioplegia for myocardial protection during cardiac surgery? A meta-analysis of 5576 patients from 36 randomized trials. Perfusion, 2012, 27(6): 535-546.
4.	Edelman JJB, Seco M, Dunne B, et al. Custodiol for myocardial protection and preservation: a systematic review. Ann Cardiothorac Surg, 2013, 2(6): 717-728.
5.	Ferguson ZG, Yarborough DE, Jarvis BL, et al. Evidence-based medicine and myocardial protection--where is the evidence? Perfusion, 2015, 30(5): 415-422.
6.	Gebhard MM, Preusse CJ, Schnabel PA, et al. Different effects of cardioplegic solution HTK during single or intermittent administration. Thorac Cardiovasc Surg, 1984, 32(5): 271-276.
7.	Bretschneider HJ. Myocardial protection. Thorac Cardiovasc Surg, 1980, 28(5): 295-302.
8.	Careaga G, Salazar D, Tellez S, et al. Clinical impact of histidine-ketoglutaratetryptophan (HTK) cardioplegic solution on the perioperative period in open heart surgery patients. Arch Med Res, 2001, 32(4): 296 -299.
9.	Liu J, Feng Z, Zhao J, et al. The myocardial protection of HTK cardioplegic solution on the long-term ischemic period in pediatric heart surgery. ASAIO J, 2008, 54(5): 470-473.
10.	Viana FF, Shib WY, Hayward PA, et al. Custodiol versus blood cardioplegia in complex cardiac operations: an Australian experience. Eur J Cardiothorac Surg, 2012, 43(3): 526-532.
11.	Garbade J, Davierwala P, Seeburger J, et al. Myocardial protection during minimally invasive mitral valve surgery: strategies and cardioplegic solutions. Ann Cardiothorac Surg, 2013, 2(6): 803-808.
12.	Chen Y, Liu JP, Li SJ, et al. Which is the better option during neonatal cardiopulmonary bypass: HTK solution or cold blood cardioplegia? ASAIO J, 2013, 59(1): 69-74.
13.	Braathen B, Jeppsson A, Scherstén H, et al. One single dose of histidine-tryptophan-ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repetitive cold blood cardioplegia: a prospective randomized study. J Thorac Cardiovasc Surg, 2011, 141(4): 995-1001.
14.	Marui A, Kimura T, Nishiwaki N, et al. Comparison of five-year outcomes of coronary artery bypass grafting versus percutaneous coronary intervention in patients with left ventricular ejection fractions≤50% versus >50% (from the CREDO-Kyoto PCI/CABG Registry Cohort-2). Am J Cardiol, 2014, 114(7): 988-996.
15.	Keogh B. The Society of Cardiothoracic Surgeons of Great Britain and Ireland fifth national adult cardiac surgical database report. Henley-on-Thames, UK: Dendrite Clinical Systems, 2003.
16.	Ahmed WA, Tully PJ, Baker RA, et al. Survival after isolated coronary artery bypass grafting in patients with severe left ventricular dysfunction. Ann Thorac Surg, 2009, 87(4): 1106-1112.
17.	刘盛,胡盛寿,王巍,等. 冠状动脉旁路移植术治疗缺血性心功能不全患者的远期疗效. 中国胸心血管外科临床杂志,2010, 17(3): 188-191.
18.	Gao Z, Xu B, Ajay J. et al. Impact of depressed left ventricular function on outcomes in patients with three-vessel coronary disease undergoing percutaneous coronary intervention. Chin Med J, 2013, 126(4): 609-614.
19.	王嵘, 高长青, 肖苍松, 等. 外科血运重建治疗缺血性心脏病合并左心功能不全的远期效果分析. 中华医学杂志, 2016, 96(15): 1178-1182.

1. 王嵘,高长青,肖苍松, 等. 外科血运重建治疗缺血性心脏病左心功能不全的早期结果及危险因素分析. 中国胸心血管外科临床杂志, 2015, 22(10): 954-960.
2. Guru V, Omura J, Alghamdi AA, et al. Is blood superior to crystalloid cardioplegia? A Meta-analysis of randomized clinical trials. Circulation, 2006, 114[Suppl I]: I-331-I-338.
3. Sá MPBO, Rueda FG, Ferraz PE, et al. Is there any difference between blood and crystalloid cardioplegia for myocardial protection during cardiac surgery? A meta-analysis of 5576 patients from 36 randomized trials. Perfusion, 2012, 27(6): 535-546.
4. Edelman JJB, Seco M, Dunne B, et al. Custodiol for myocardial protection and preservation: a systematic review. Ann Cardiothorac Surg, 2013, 2(6): 717-728.
5. Ferguson ZG, Yarborough DE, Jarvis BL, et al. Evidence-based medicine and myocardial protection--where is the evidence? Perfusion, 2015, 30(5): 415-422.
6. Gebhard MM, Preusse CJ, Schnabel PA, et al. Different effects of cardioplegic solution HTK during single or intermittent administration. Thorac Cardiovasc Surg, 1984, 32(5): 271-276.
7. Bretschneider HJ. Myocardial protection. Thorac Cardiovasc Surg, 1980, 28(5): 295-302.
8. Careaga G, Salazar D, Tellez S, et al. Clinical impact of histidine-ketoglutaratetryptophan (HTK) cardioplegic solution on the perioperative period in open heart surgery patients. Arch Med Res, 2001, 32(4): 296 -299.
9. Liu J, Feng Z, Zhao J, et al. The myocardial protection of HTK cardioplegic solution on the long-term ischemic period in pediatric heart surgery. ASAIO J, 2008, 54(5): 470-473.
10. Viana FF, Shib WY, Hayward PA, et al. Custodiol versus blood cardioplegia in complex cardiac operations: an Australian experience. Eur J Cardiothorac Surg, 2012, 43(3): 526-532.
11. Garbade J, Davierwala P, Seeburger J, et al. Myocardial protection during minimally invasive mitral valve surgery: strategies and cardioplegic solutions. Ann Cardiothorac Surg, 2013, 2(6): 803-808.
12. Chen Y, Liu JP, Li SJ, et al. Which is the better option during neonatal cardiopulmonary bypass: HTK solution or cold blood cardioplegia? ASAIO J, 2013, 59(1): 69-74.
13. Braathen B, Jeppsson A, Scherstén H, et al. One single dose of histidine-tryptophan-ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repetitive cold blood cardioplegia: a prospective randomized study. J Thorac Cardiovasc Surg, 2011, 141(4): 995-1001.
14. Marui A, Kimura T, Nishiwaki N, et al. Comparison of five-year outcomes of coronary artery bypass grafting versus percutaneous coronary intervention in patients with left ventricular ejection fractions≤50% versus >50% (from the CREDO-Kyoto PCI/CABG Registry Cohort-2). Am J Cardiol, 2014, 114(7): 988-996.
15. Keogh B. The Society of Cardiothoracic Surgeons of Great Britain and Ireland fifth national adult cardiac surgical database report. Henley-on-Thames, UK: Dendrite Clinical Systems, 2003.
16. Ahmed WA, Tully PJ, Baker RA, et al. Survival after isolated coronary artery bypass grafting in patients with severe left ventricular dysfunction. Ann Thorac Surg, 2009, 87(4): 1106-1112.
17. 刘盛,胡盛寿,王巍,等. 冠状动脉旁路移植术治疗缺血性心功能不全患者的远期疗效. 中国胸心血管外科临床杂志,2010, 17(3): 188-191.
18. Gao Z, Xu B, Ajay J. et al. Impact of depressed left ventricular function on outcomes in patients with three-vessel coronary disease undergoing percutaneous coronary intervention. Chin Med J, 2013, 126(4): 609-614.
19. 王嵘, 高长青, 肖苍松, 等. 外科血运重建治疗缺血性心脏病合并左心功能不全的远期效果分析. 中华医学杂志, 2016, 96(15): 1178-1182.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

HTK versus Blood Cardioplegia for Myocardial Protection in Patients with Complex Coronary Artery Disease and Left Ventricular Dysfunction: A Case Control Study

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