Comparative Analysis of Myocardial Protection with HTK Solution and Hypothermic Hyperkalemic Blood Solution in the Correction of Acyanogenic Congenital Cardiopathies - A Randomized Study

Braz J Cardiovasc Surg. 2019 Jun 1;34(3):271-278. doi: 10.21470/1678-9741-2018-0243.

Abstract

Objective: The goal of the present study was to compare the myocardial protection obtained with histidine-tryptophan-ketoglutarate (HTK) cardioplegic solution (Custodiol®) and with intermittent hypothermic blood solution.

Methods: Two homogenous groups of 25 children with acyanotic congenital heart disease who underwent total correction with mean aortic clamping time of 60 minutes were evaluated in this randomized study. Troponin and creatine kinase-MB curves, vasoactive-inotropic score, and left ventricular function were obtained by echocardiogram in each group. The values were correlated and presented through graphs and tables after adequate statistical treatment.

Results: It was observed that values of all the studied variables varied over time, but there was no difference between the groups.

Conclusion: We conclude that in patients with acyanotic congenital cardiopathies submitted to total surgical correction, mean aortic clamping time around one hour, and cardiopulmonary bypass with moderate hypothermia, the HTK crystalloid cardioplegic solution offers the same myocardial protection as the cold-blood hyperkalemic cardioplegic solution analyzed, according to the variables considered in our study model.

Keywords: Cardiopulmonary Bypass; Cardiopulmonary Bypass, CPB (Incl Set-Ups, Equipment, Surface Coatings, Etc.), Pediatric; Congenital Heart Disease, CHD; Myocardial Injury (Incl Blunt, Penetrating, Iatrogenic); Myocardial Protection/Cardioplegia.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Analysis of Variance
  • Cardioplegic Solutions / therapeutic use*
  • Creatine Kinase, MB Form / analysis
  • Double-Blind Method
  • Echocardiography
  • Female
  • Glucose / therapeutic use
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Mannitol / therapeutic use
  • Operative Time
  • Potassium Chloride / therapeutic use
  • Procaine / therapeutic use
  • Prospective Studies
  • Protective Agents / therapeutic use
  • Reference Values
  • Reproducibility of Results
  • Statistics, Nonparametric
  • Time Factors
  • Treatment Outcome
  • Troponin / analysis
  • Ventricular Function, Left

Substances

  • Bretschneider cardioplegic solution
  • Cardioplegic Solutions
  • Protective Agents
  • Troponin
  • Mannitol
  • Procaine
  • Potassium Chloride
  • Creatine Kinase, MB Form
  • Glucose