Departments of Cardiovascular Surgery and Pathology, Başkent University Hospital, Ankara, Turkey.
Artif Organs. 2013 Jan;37(1):76-81. doi: 10.1111/j.1525-1594.2012.01575.x.
Cardioplegic arrest is one of the most common myocardial protection strategies. A wide variety of cardioplegic solutions are routinely being used. There is an ongoing discussion about the relative effectiveness of these solutions considering myocardial protection. This study aims to investigate the hypothesis that the use of histidine-tryptophan-ketoglutarate (HTK) cardioplegia leads to decreased ischemic damage on myocardium compared with the use of conventional crystalloid cardioplegia. The study population was 32 patients operated on at Başkent University, Department of Cardiovascular Surgery for congenital heart diseases. The first group of 16 patients received conventional crystalloid cardioplegia (KK group) which is a modification of St. Thomas' solution, while the second group of 16 patients received HTK solution (HTK group). The echocardiographic measurements and the laboratory values of the patients were taken as the clinical variables. Right ventricular biopsies were taken from every patient before and after cardioplegic arrest. These biopsies were histopathologically examined for apoptosis using caspase-3 antigen and cell proliferation using Ki-67 antigen. The statistical analysis revealed no significant difference between the two groups regarding the clinical variables, apoptotic indices and proliferation indices. The apoptotic indices in the postcardioplegic arrest biopsies positively correlated with aortic clamp time in the KK group but not in the HTK group. Liver function tests on postoperative day 1 positively correlated with aortic clamp time in both groups. On postoperative day 2, this correlation was sustained in the KK group and ceased in HTK group. The difference in the correlation of apoptotic indices and liver function tests between the groups is accepted as a supportive finding for HTK solution. However, it can be postulated that when the aortic clamp times are similar to those in the present study, the clinical manifestation of the difference between the two solutions would not be significant.
心脏停搏是最常见的心肌保护策略之一。目前常规使用多种心脏停搏液。关于这些溶液在心肌保护方面的相对有效性，目前仍在进行讨论。本研究旨在验证以下假设：与使用传统晶体心脏停搏液相比，使用组氨酸-色氨酸-酮戊二酸（HTK）心脏停搏液可减少心肌缺血损伤。研究人群为在巴什肯特大学心血管外科系接受先天性心脏病手术的 32 名患者。第一组 16 名患者接受传统晶体心脏停搏液（KK 组），即托马斯溶液的改良液，而第二组 16 名患者接受 HTK 溶液（HTK 组）。患者的超声心动图测量值和实验室值作为临床变量。从每位患者在心脏停搏前后采集右心室活检。使用 caspase-3 抗原和 Ki-67 抗原对这些活检组织进行组织病理学检查，以评估细胞凋亡和细胞增殖。统计分析显示，两组之间在临床变量、凋亡指数和增殖指数方面无显著差异。KK 组心脏停搏后活检组织中的凋亡指数与主动脉夹闭时间呈正相关，但 HTK 组无此相关性。两组患者术后第 1 天的肝功能检查与主动脉夹闭时间呈正相关。术后第 2 天，KK 组这种相关性仍在维持，而 HTK 组已停止。两组之间凋亡指数和肝功能检查相关性的差异被认为是 HTK 溶液的支持性发现。然而，可以推测，当主动脉夹闭时间与本研究相似时，两种溶液之间的差异在临床表现上不会很明显。
