Savini C, Camurri N, Castelli A, Dell'Amore A, Pacini D, Suarez S Martin, Grillone G, Di Bartolomeo R
Department of Cardiovascular Surgery, Ospedale S.Orsola-Malpighi, University of Bologna, Italy.
Heart Surg Forum. 2005;8(1):E25-7. doi: 10.1532/HSF98.20041145.
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.
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.
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.
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.
微创心脏手术（MICS）是一种安全且令人满意的手术方法，主要用于二尖瓣手术，在许多中心都取得了优异的效果。心脏停搏液的应用仍然可能是一个问题，尤其是在使用主动脉内阻断钳时。我们回顾性分析了在微创心脏手术中使用组氨酸 - 色氨酸 - 酮戊二酸（HTK）溶液进行心肌保护的早期结果。
2003年2月至2004年2月期间，8例患者使用体外循环（CPB）系统和HTK溶液作为心肌保护进行二尖瓣手术。患者平均年龄为67.7±9.2岁，所有患者术前射血分数均正常。3例患者进行瓣膜修复，5例患者进行瓣膜置换。平均CPB时间为129.2±19.4分钟，主动脉阻断时间为88.5±15.4分钟。
在每种情况下，HTK溶液仅在手术开始时用于单次心脏停搏剂量，无需再次给药。8例患者中有6例（75%）在再灌注时心脏自动复跳，术后期间心电图结果或心肌细胞坏死酶（肌酸激酶及其MB同工酶）无明显变化。
HTK溶液是一种冷晶体心脏停搏液，已证明其在微创心脏手术中的效用，因为它提供了安全的长时间心脏停搏时间，并降低了由于主动脉内阻断钳移位导致冠状动脉灌注不足的风险。
