Clinical assessment of prolonged myocardial preservation using Histidine Tryptophan-alpha Ketoglutarate (HTK) solution

Myocardial preservation during open heart operations has been well established, & various cardioplegic methods have been clinically introduced. we focused on patients who needed prolonged cross clamp period & evaluated the efficacy of preservation using two different cardioplegic methods. One is commonly used blood cardioplegia (cold or isothermic/tepid) & the other is Histidine Tryptophan-alpha Ketoglutarate (HTK) crystalloid solution—a multiorgan preservative used as cardioplegia. HTK solution, a crystalloid cardioplegic solution (custodial solution), allows us to operate without interruption for about 120 minutes.

Twenty Eight patients who underwent cardiac procedure between Jan 2007 to Oct 2009 were enrolled in this study. Patients with aortic cross clamp time near or more than 2 hrs with blood cardioplegia were non randomly selected (n=14) and compared with custodial group (n=14). There were no difference between the two groups with regard to age, body surface area (BSA) & cardiopulmonary bypass time (>3hrs.) & cross clamp time (>2hrs).

Our clinical evaluation reveals the superiority of HTK solution over the blood cardioplegia in the following context: Onset of spontaneous sinus rhythm after removal of cross clamp.

Nil or very minimal inotropic support.