Key result
HTK perfusion is linked to ~85% lower early mortality vs St. Thomas' solution in high-risk pediatrics.
Why the study?
Does a single perfusion with histidine-tryptophan-ketoglutarate (HTK) solution reduce early mortality and morbidity compared to St. Thomas' solution in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease undergoing arterial switch operation?
Cohort (n=101)
No
Does a single perfusion with histidine-tryptophan-ketoglutarate (HTK) solution reduce early mortality and morbidity compared to St. Thomas' solution in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease undergoing arterial switch operation?
HTK solution decreases early mortality, morbidity, and resource utilization compared to St. Thomas' solution in high-risk patients undergoing arterial switch operations.
Answers are grounded in this paper and cite their sources.
Single HTK perfusion may aid myocardial protection in high-risk PAH-CHD surgery; leaves open need for randomized confirmation.
Cardioplegic reperfusion during a long term ischemic period interrupts cardiac surgery and also increases cellular edema due to repeated solution administration. We reviewed the clinical experiences on myocardial protection of a single perfusion with histidine-tryptophan-ketoglutarate (HTK) for high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease. This retrospective study included 101 high-risk patients undergoing arterial switch operation between March 2001 and July 2012. We divided the cohort into two groups: HTK group, myocardial protection was carried out with one single perfusion with HTK solution; and St group, myocardial protection with conventional St. Thomas' crystalloid cardioplegic solution. The duration of cardiopulmonary bypass did not differ between the two groups. The mortality, morbidity, ICU stay, post-operative hospitalization time, and number of transfusions in HTK group were lower than those in St group (P<0.05). Univariate and multivariate analysis showed that HTK is a statistically significant independent predictor of decreased early mortality and morbidity (P<0.05). In conclusion, HTK solution seems to be an effective and safe alternative to St. Thomas' solution for cardioplegic reperfusion in high-risk patients with complex congenital heart disease.
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Li et al. (2016) conducted a cohort in Severe pulmonary arterial hypertension associated with complex congenital heart disease (n=101). Histidine-tryptophan-ketoglutarate (HTK) solution vs. St. Thomas' cold potassium crystalloid cardioplegic solution was evaluated on Early mortality (death before hospital discharge or within 30 days of arterial switch operation) (OR 0.151, p=0.035). A single perfusion of histidine-tryptophan-ketoglutarate solution significantly reduced early mortality (2.7% vs 15.4%, OR 0.151) compared to St. Thomas' solution in high-risk pediatric patients.
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