ObjectiveTo compare the myocardial protective effect of HTK solution and St.ThomasⅡ(STH) solution in immature rabbit myocardium at different cardiac arrest time. MethodsAccording to cardioplegia and cardiac arrest time, 32 immature New Zealand white rabbits (aged 2-3 weeks) were randomly divided into four groups. A group SO (8 rabbits) underwent 1 hour cardiac arrest with STH solution, a group ST (8 rabbits) underwent 2 hours cardiac arrest with STH solution, a group HO (8 rabbits) underwent 1 hour cardiac arrest with HTK solution, a group Ht (8 rabbits) underwent 2 hours cardiac arrest with HTK solution. Compare the myocardial protective effect of HTK and STH solution in immature myocardium at different cardiac arrest time. ResultsThe Langendorff models were successfully established in 30 cases (8 cases in the group SO and HO, 7 cases in the group ST and HT). There were no statistical differences in hemodynamics and myocardial enzyme (CK-MB, LDH) (P > 0.05), but HTK solution reduced the activity of nitric oxide synthase (NOS) and content of malonaldehyde (MDA) and NO, maintained high activity of superoxide dismutase (SOD) and Ca2+-ATPase (P < 0.05), performed more effective myocardial protection for immature myocardium. ConclusionHTK solution has more effective myocardial protection for immature myocardium than STH solution does, but STH solution still has good outcomes within short cardiac arrest time (1h).
ObjectiveTo 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. MethodsFrom 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. ResultsAccording 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. ConclusionFor 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.
ObjectiveTo compare the clinical effects of two commonly used organ preservation solutions University of Wisconsin (UW) solution and histidine-tryptophan-ketoglutarate (HTK) solution in liver transplantation.MethodsThe PubMed, Embase, Cochrane Library, CNKI, CBM, VIP, and Wanfang Data were searched to collect the comparative studies of the UW solution and HTK solution in the liver transplantation. The data were extracted and evaluated by the RevMan 5.3 software.ResultsFinally, 16 articles with a total of 35 024 patients were included. The meta-analysis results showed that the HTK solution group had a lower incidence of postoperative biliary complications [RR=1.30, 95%CI (1.07 1.58), P=0.008] and lower aspartate aminotransferase peak level within 7 d after operation [MD=112.45, 95%CI (93.34, 131.56), P<0.01] as compared with the UW solution group. No significant differences were found in terms of the incidence of primary non-function [RR=1.07, 95%CI (0.52, 2.18), P=0.86], survival rates of patient and graft in different time points (P>0.05), incidence of retransplantation [RR=0.83, 95%CI (0.48, 1.45), P=0.51], incidence of acute rejection [RR=1.27, 95%CI (0.96, 1.68), P=0.33], alanine aminotransferase peak level within 7 d [MD=31.79, 95%CI (–161.84, 225.42), P=0.75] after operation, total bilirubin [MD=19.42, 95%CI (–10.83, 49.67), P=0.21], and prothrombin time [MD=1.75, 95%CI (0.01, 3.49), P=0.84] between these two groups.ConclusionsHTK solution is safe and effective for liver transplantation, and has similar effects as UW solution. Regarding effect of both on long-term survival rates of patient and graft, large-sample and high-quality RCT is still needed for systematic evaluation.