Reynolds Alexander C, Asopa Sanjay, Modi Amit, King Nicola
Swansea University Medical School, Swansea, UK.
South West Cardiothoracic Centre, University Hospitals Plymouth, Plymouth, UK.
J Card Surg. 2021 Apr;36(4):1334-1343. doi: 10.1111/jocs.15397. Epub 2021 Feb 5.
Histidine-tryptophan-ketoglutarate (HTK) cardioplegia for myocardial protection obviates the need for maintenance cardioplegia doses, and thus allows for greater focus on procedure accuracy. The aim of this meta-analysis is to evaluate the safety and efficacy of HTK versus multidose cardioplegias during cardiac surgery in an adult population.
Electronic searches were performed using PubMed, Science Direct, and Google Scholar databases. The key search terms included HTK cardioplegia AND cardiac surgery AND adult. This was followed by a meta-analysis investigating cardiopulmonary bypass (CPB) duration, cross-clamp duration, spontaneous defibrillation, inotropic support, mortality, atrial fibrillation, creatine kinase muscle brain band (CK-MB) and troponin I (TnI).
Seven randomized controlled trials (n = 804) were analyzed. Spontaneous defibrillation following aortic cross-clamp removal significantly favored HTK (odds ratio [OR], 2.809; 95% confidence interval [CI], 1.574 to 5.012; I = 0%; p < .01). There were no other notable significant differences between HTK and multidose cardioplegia in any of the parameters measured. In particular, the OR for mortality was 1.237 (95% CI, 0.385 to 3.978; I = 0%; p = .721) and the mean difference for CPB duration overall was 2.072 min (95% CI, -2.405 to 6.548; I = 74%; p = .364).
HTK is safe and effective during adult cardiac surgery when compared with multidose cardioplegias for myocardial protection during surgical correction of acquired pathology in the adult population. HTK may, therefore, be suitable for complex cases or those of extensive duration, without the prospect of increased postoperative morbidity or mortality.
用于心肌保护的组氨酸 - 色氨酸 - 酮戊二酸（HTK）心脏停搏液无需维持剂量的心脏停搏液，因此可以更专注于手术操作的准确性。本荟萃分析的目的是评估在成人心脏手术中HTK与多剂量心脏停搏液相比的安全性和有效性。
使用PubMed、Science Direct和谷歌学术数据库进行电子检索。关键检索词包括HTK心脏停搏液、心脏手术和成人。随后进行荟萃分析，研究体外循环（CPB）持续时间、主动脉阻断时间、自发除颤、血管活性药物支持、死亡率、心房颤动、肌酸激酶同工酶（CK-MB）和肌钙蛋白I（TnI）。
分析了7项随机对照试验（n = 804）。主动脉阻断解除后的自发除颤明显有利于HTK（优势比[OR]，2.809；95%置信区间[CI]，1.574至5.012；I² = 0%；p <.01）。在任何测量参数中，HTK与多剂量心脏停搏液之间没有其他显著差异。特别是，死亡率的OR为1.237（95% CI，0.385至3.978；I² = 0%；p = 0.721），总体CPB持续时间的平均差异为2.072分钟（95% CI，-2.405至6.548；I² = 74%；p = 0.364）。
在成人心脏手术中，与多剂量心脏停搏液相比，HTK在成人获得性病变手术矫正期间用于心肌保护是安全有效的。因此，HTK可能适用于复杂病例或手术时间长的病例，且不会增加术后发病率或死亡率。
