Department of Anaesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Anaesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
J Cardiothorac Vasc Anesth. 2024 Nov;38(11):2643-2650. doi: 10.1053/j.jvca.2024.07.038. Epub 2024 Jul 23.
This study was conducted to compare the efficacy of histidine-tryptophan-ketoglutarate (HTK) cardioplegia and cold blood cardioplegia (CBC), especially for postoperative right ventricular (RV) function after tetralogy of Fallot repair.
Randomized, double-blinded, parallel-group, controlled clinical trial.
Ain Shams University Hospitals.
A total of 100 children (1 to 5 years old) scheduled for tetralogy of Fallot repair.
Patients were allocated (double-blinded 1:1 allocation ratio) to either the HTK group that received HTK cardioplegia (30 mL/kg via antegrade route) or the CBC group that received cold blood cardioplegia with blood-to-Ringer solution (4:1) in a volume of 20 mL/kg.
The HTK group showed a statistically significant reduction of the vasoactive inotropic score on admission to the pediatric intensive care unit (13.0 ± 4.1) in comparison to the CBC group (15.5 ± 5.4), with a p value of 0.011. However, after 24 hours, the vasoactive-inotropic score was comparable. Lactate level during the first 24 hours was 6.2 ± 0.7 mmol/L in the HTK group and 6.9 ± 0.4 mmol/L in the CBC group (p < 0.0001). Serial troponin measurements were lower in the HTK group (1.49 ± 0.45) compared to the CBC group (1.69 ± 0.18) at the first 72 hours postoperatively (p = 0.005). Postoperative echocardiographic assessment of RV function by means of tricuspid annular plane systolic excursion and myocardial performance index were better in the HTK group than in the CBC grpup (p < 0.05).
HTK cardioplegia may offer better cardiac protection to pediatric patients undergoing tetralogy of Fallot repair than our institutional standard CBC with better recovery for the hypertrophic RV.
本研究旨在比较组氨酸-色氨酸-酮戊二酸（HTK）心脏停搏液和冷血心脏停搏液（CBC）的疗效，特别是在法洛四联症修复术后右心室（RV）功能方面。
随机、双盲、平行组、对照临床试验。
艾因夏姆斯大学医院。
共 100 名（1 至 5 岁）计划接受法洛四联症修复术的儿童。
患者被分配（双盲 1:1 分配比例）至 HTK 组，给予 HTK 心脏停搏液（通过顺行途径给予 30 mL/kg），或 CBC 组，给予冷血心脏停搏液与血液-Ringer 溶液（4:1），体积为 20 mL/kg。
HTK 组在进入儿科重症监护病房时的血管活性正性肌力评分（13.0±4.1）显著低于 CBC 组（15.5±5.4），p 值为 0.011。然而，24 小时后，血管活性正性肌力评分相当。HTK 组在前 24 小时的乳酸水平为 6.2±0.7mmol/L，而 CBC 组为 6.9±0.4mmol/L（p<0.0001）。HTK 组在术后前 72 小时的肌钙蛋白测量值较低（1.49±0.45），而 CBC 组为 1.69±0.18（p=0.005）。通过三尖瓣环平面收缩期位移和心肌收缩指数对 RV 功能进行术后超声心动图评估，HTK 组优于 CBC 组（p<0.05）。
HTK 心脏停搏液可为接受法洛四联症修复术的儿科患者提供比我们机构标准的 CBC 更好的心脏保护，从而使肥厚的 RV 更好地恢复。
