A comparative study of Histidine-Tryptophan-Ketoglutarate (HTK) solution vs blood cardioplegia in combined coronary artery and valve surgery

Background: Ischemic heart disease is increasingly prevalent, leading to more patients undergoing open-heart surgeries such as coronary artery bypass grafting (CABG) and valve procedures. Myocardial protection is crucial, yet the optimal cardioplegic solution remains debated. This study compared histidine–tryptophan–ketoglutarate (HTK) solution with standard tepid blood cardioplegia in combined CABG and valve surgery. Aim: To evaluate the safety and effectiveness of HTK versus tepid blood cardioplegia in combined CABG and valve surgery. Methods: Thirty patients scheduled for combined CABG and valve surgery were prospectively enrolled and randomized into two age- and sex-matched groups (n = 15 each). Group A received HTK cardioplegia, and Group B received blood cardioplegia. Intraoperative and postoperative outcomes were assessed and compared. Results: Baseline demographic, echocardiographic, and operative characteristics were similar between groups (all p > 0.05). The blood cardioplegia group had significantly lower peak postoperative troponin I levels compared with the HTK group (p = 0.021) and shorter inotropic support duration (p = 0.038). No significant differences were observed in postoperative left ventricular ejection fraction, intensive care unit stay, or total hospital stay (all p > 0.05). Conclusion: Both HTK and blood cardioplegia provided adequate myocardial protection during prolonged combined CABG and valve procedures. Blood cardioplegia was associated with reduced myocardial injury markers and shorter inotropic support requirements, suggesting a potential benefit in high-risk patients. Larger, multicenter randomized trials are needed to validate these findings.