Efficacy of Histidine–Tryptophan–Ketoglutarate Solution Versus Blood Cardioplegia in Cardiac Surgical Procedures: A Randomized Controlled | Parallel Group Study


  • Ihab Ali, MD, FRCS (C-Th) Cardiothoracic Surgery Department, Faculty of Medicine – Ain Shams University, Cairo, Egypt
  • Ahmed Hassan, MSc Cardiothoracic Surgery Department, Faculty of Medicine – Ain Shams University, Cairo, Egypt
  • Hoda Shokri, MD Department of Anesthesiology and Intensive Care, Faculty of Medicine - Ain Shams University, Cairo, Egypt
  • Ramy Khorshid, MD Cardiothoracic Surgery Department, Faculty of Medicine – Ain Shams University, Cairo, Egypt




Blood cardioplegia, cardiac procedures , HTK solution, Custodiol


Background: In cardiac surgery, myocardial protection is required during cross-clamping followed by reperfusion. The use of cardioplegic solutions helps preserve myocardial energy stores, hindering electrolyte disturbances and acidosis during periods of myocardial ischaemia. This study aimed to compare the efficacy and safety between the histidine–tryptophan–ketoglutarate (HTK) solution and blood cardioplegia in various cardiac surgeries.

Methods: Three-hundred-twenty patients aged 30-70 years old undergoing various cardiac surgeries were randomized into the HTK group and the blood cardioplegia group. The ventilation time, total bypass time, cross-clamp time, length of intensive care unit (ICU) or hospital stay, and postoperative complications were analyzed.

Results: The total bypass time and cross-clamp time were significantly shorter in the HTK group than in the blood cardioplegia group (P < 0.001). Segmental wall motion abnormalities (SWMA) at postoperative echocardiography were significantly higher in in the blood cardioplegia group (P = 0.008). The number of patients requiring DC Shock was significantly higher in the HTK group (P < 0.001). The number of patients requiring inotropic support was significantly higher in the blood cardioplegia group (P < 0.001). The length of ICU, hospital stay, and ventilation time were significantly longer in the blood cardioplegia group than in the HTK group (P = 0.004, P < 0.001, P < 0.001, respectively). The number of patients requiring prolonged ventilation was significantly higher in the blood cardioplegia group compared with the HTK group (P = 0.022). There was no significant difference between the study groups regarding electrocardiographic changes, 30-day mortality, and 30-day readmission.

Conclusion: The use of HTK cardioplegia was associated with significantly shorter cross-clamp time, bypass time, duration of mechanical ventilation, length of ICU stay, and length of hospital stay. It is associated with less incidence of postoperative segmental wall abnormalities and less need for inotropic support than blood cardioplegia. Custodiol cardioplegia is a safe and feasible option that can be used as an effective substitute for blood cardioplegia to enhance myocardial protection.


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How to Cite

Ali, I., Hassan, A., Shokri, H. ., & Khorshed, R. (2021). Efficacy of Histidine–Tryptophan–Ketoglutarate Solution Versus Blood Cardioplegia in Cardiac Surgical Procedures: A Randomized Controlled | Parallel Group Study. The Heart Surgery Forum, 24(1), E170-E176. https://doi.org/10.1532/hsf.3495