Myocardial Protection Using HTK Solution in Minimally Invasive Mitral Valve Surgery
Background: Minimally invasive cardiac surgery (MICS) is a safe and satisfactory approach used mainly in mitral valve surgery with excellent results in many centers. Cardioplegia administration can be still a problem, especially when an endoaortic clamp is used. We retrospectively analyzed our early results with histidine-triptophane-ketoglutarate (HTK) solution used for myocardial protection in MICS.
Methods: Between February 2003 and February 2004, 8 patients underwent mitral valve surgery using an endo- cardiopulmonary bypass (CPB) system and HTK solution as myocardial protection. The mean patient age was 67.7 ± 9.2 years, and the preoperative ejection fraction was normal in all patients. Three patients had valve repair and 5 had valve replacement. Mean CPB time was 129.2 ± 19.4 minutes, and aortic cross-clamp duration was 88.5 ± 15.4 minutes. Results: In every case HTK solution was used for only a single dose for cardioplegia at the beginning of the procedure, without any recalls. The heart restarted spontaneously at reperfusion in 6 of 8 cases (75%), and there were no significant modifications in electrocardiogram results or myocardial cytonecrosis enzymes (creatine kinase and its MB fraction) during the postoperative period.
Conclusions: HTK solution is a cold crystalloid cardioplegia solution that has demonstrated its utility in MICS because it provides a safe long cardioplegic arrest time and it reduces the risk of inadequate coronary perfusion due to dislodgement of the endoaortic clamp.
Bretschneider HJ, Gebhard MM, Preusse CJ. 1980. Optimization of myocardial protection. In: Heiss EW, editor. Advances in clinical cardiology. Volume 1. New York: G. Witzstrock. p 581-591.nChitwood WR Jr. 2000. Video-assisted mitral valve surgery: using the Chitwood clamp. Oper Techn Thorac Cardiovasc Surg 5:190-202.nChitwood WR Jr, Elbeery JR, Moran JM. 1997. Minimally invasive mitral valve repair: using a mini-thoracotomy and transthoracic aortic occlusion. Ann Thorac Surg 63:1477-9.nGallandat Huet RCG, Karliczek GF, Homan von der Heide JN, et al. 1988. Clinical effect of Bretschneider--HTK and St. Thomas cardioplegia on hemodynamic performance after bypass measured using an automatic datalogging database system. J Thorac Cardiovasc Surg 36:151-6.nMohr FW, Onnasch JF, Falk V, et al. 1999. The evolution of minimally invasive valve surgery--2-year experience. Eur J Cardiothorac Surg 15:233-8.nPeters WS. 1993. Minimally invasive cardiac surgery by cardioscopy. Australas J Card Thorac Surg 2:152-4.nPreusse CL, Winter J, Shulte HB, Bircks W. 1985. Energy demand of cardioplegically perfused hearts. J Cardiovasc Surg 26:558-63.nSchroeyers P, Wellens F, De Geest R, et al. 2001. Minimally invasive video assisted mitral valve surgery: our lessons after a 4-year experience. Ann Thorac Surg 72:S1050-4.nSchwartz DS, Ribakove GH, Grossi EA, et al. 1996. Minimally invasive cardiopulmonary bypass with cardioplegic arrest: a closed chest technique with equivalent myocardial protection. J Thorac Cardiovasc Surg 111:556-66.nSunderdiek U, Feindt P, Gams E. 2000. Aorto-coronary bypass grafting: a comparison of HTK cardioplegia vs. intermittent aortic cross-clamping. Eur J Cardiothor Surg 18:393-9.n
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