The Journal of Thoracic and Cardiovascular Surgery
Volume 141, Issue 4 , Pages 995-1001, April 2011

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

  • Bjørn Braathen, MD

      Affiliations

    • Department of Cardiothoracic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
    • ,
  • Anders Jeppsson, MD, PhD

      Affiliations

    • Department of Cardiovascular Surgery and Anesthesia, Sahlgrenska University Hospital, Gothenburg, Sweden
    • Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
    • ,
  • Henrik Scherstén, MD, PhD

      Affiliations

    • Department of Cardiovascular Surgery and Anesthesia, Sahlgrenska University Hospital, Gothenburg, Sweden
    • Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
    • ,
  • Ole M. Hagen, MD

      Affiliations

    • Department of Cardiothoracic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
    • ,
  • Øystein Vengen, MD, PhD

      Affiliations

    • Department of Cardiothoracic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
    • ,
  • Helena Rexius, MD, PhD

      Affiliations

    • Department of Cardiovascular Surgery and Anesthesia, Sahlgrenska University Hospital, Gothenburg, Sweden
    • Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
    • ,
  • Vincenzo Lepore, MD, PhD

      Affiliations

    • Department of Cardiovascular Surgery and Anesthesia, Sahlgrenska University Hospital, Gothenburg, Sweden
    • Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
    • ,
  • Theis Tønnessen, MD, PhD

      Affiliations

    • Department of Cardiothoracic Surgery, Oslo University Hospital Ullevål, Oslo, Norway
    • University of Oslo, Faculty of Hospital Medicine and Center for Heart Failure Research, Oslo, Norway
    • Corresponding Author InformationAddress for reprints: Theis Tønnessen, MD, PhD, Department of Cardiothoracic Surgery, Oslo University Hospital Ullevål, and University of Oslo, Faculty of Hospital Medicine, Oslo, Norway.

Received 18 March 2010; received in revised form 31 May 2010; accepted 5 July 2010. published online 30 August 2010.

Objectives

Histidine-tryptophan-ketoglutarate (HTK–Custodiol) cardioplegic solution is administered as one single dose for more than 2 hours of ischemia. No prospective randomized clinical study has compared the effects of HTK and cold blood cardioplegia on myocardial damage in elective mitral valve surgery. Thus, the main aim of the present study was to examine whether one single dose of cold antegrade HTK gives as good myocardial protection as repetitive antegrade cold blood cardioplegia in mitral valve surgery.

Methods

Eighty consecutive patients undergoing elective isolated mitral valve surgery for mitral regurgitation, with or without ablation for atrial fibrillation, were included in the study and randomized to HTK or blood cardioplegia. Markers of myocardial injury (troponin-T and creatine kinase MB) were analyzed at baseline and 7 hours, 1 day, 2 days, and 3 days after surgery.

Results

No significant difference in creatine kinase MB and troponin-T between HTK and blood cardioplegia groups was found at any time point. There was a significant correlation between ischemic time and markers of myocardial injury in the HTK group only and significantly more spontaneous ventricular fibrillation after release of crossclamping in the HTK group.

Conclusions

One single dose of antegrade cold HTK cardioplegic solution in elective mitral valve surgery protects the myocardium equally well as repetitive antegrade cold blood cardioplegia.

CTSNet classification: 31.4, 35.4.1, 35.4.2

Abbreviations and Acronyms: CK, creatine kinase, HTK, histidine–tryptophan–ketoglutarate

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 The study was supported by The Ingegerd and Viking Olov Björk Scholarship received by Professor Theis Tønnessen and by Sahlgrenska University Hospital (ALF/LUA grant). Custodiol for this study was a generous gift from NordMedica ApS, Bredgade 41, Copenhagen, Denmark.

 ClinicalTrial.Gov. Protocol ID 2007-001780-30.

 Disclosures: Authors have nothing to disclose with regard to commercial support.

PII: S0022-5223(10)00731-2

doi:10.1016/j.jtcvs.2010.07.011

The Journal of Thoracic and Cardiovascular Surgery
Volume 141, Issue 4 , Pages 995-1001, April 2011

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