Myocardial Protection in Donor Heart Preservation: A Comparison Between Bretschneider's Histidine–Tryptophan–Ketoglutarate Solution and Cold Blood Cardioplegia

• Published in: Transplantation proceedings Vol. 46; no. 4; pp. 1077 - 1081
• Main Authors: Sung, S.-Y, Lin, C.-Y, Song, J.-Y, Tsai, Y.-T, Kao, C.-H, Lee, C.-Y, Lin, Y.-C, Hsu, P.-S, Tsai, C.-S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2014
• Subjects: Adult; Cardioplegic Solutions - therapeutic use; Chi-Square Distribution; Cold Temperature; Female; Glucose - therapeutic use; Heart Arrest, Induced - adverse effects; Heart Arrest, Induced - methods; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - surgery; Heart Transplantation - adverse effects; Heart Transplantation - mortality; Hemodynamics - drug effects; Hospitals, General; Humans; Intensive Care Units; Length of Stay; Male; Mannitol - therapeutic use; Middle Aged; Multivariate Analysis; Myocardial Contraction - drug effects; Myocardial Reperfusion Injury - diagnosis; Myocardial Reperfusion Injury - etiology; Myocardial Reperfusion Injury - physiopathology; Myocardial Reperfusion Injury - prevention & control; Organ Preservation - adverse effects; Organ Preservation - methods; Organ Preservation Solutions - therapeutic use; Potassium Chloride - therapeutic use; Procaine - therapeutic use; Retrospective Studies; Risk Factors; Stroke Volume - drug effects; Surgery; Taiwan; Time Factors; Tissue and Organ Harvesting - adverse effects; Treatment Outcome; Ventricular Function, Left - drug effects; Taiwan
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2013.11.056

Abstract Background Optimal myocardial protection for donated hearts is crucial to improve outcomes of heart transplantation and reduce morbidity and mortality. This study aimed to compare the efficacy of myocardial protection using single dose of Bretschneider's histidine–tryptophan–ketoglutarate (HTK) solution and repeated doses of cold blood cardioplegia (CBC) in donor heart preservation. Methods Sixty-seven patients undergoing heart transplantation in Tri-Service General Hospital, Taipei, Taiwan between 2002 and 2012 were enrolled in this study. Patients were divided into an HTK group and a CBC group based on the preservation solution used to protect the donated hearts. The perioperative variables and postoperative outcomes were retrospectively reviewed. Results There were no statistic differences about demographic data in donors and recipients between the 2 groups. There were no significant differences in postoperative cardiac enzymes, hemodynamic data, length of stay in intensive care, or 30-day mortality between the groups. The HTK group showed a trend of shorter pumping time ( P  = .091). Multivariate analyses reveal that the HTK group had higher postoperative inotropic score ( P  < .001) and shorter pumping time ( P  = .02). Conclusions Single dose of Bretschneider's HTK solution could effectively reduce pumping time and afford similar myocardial protection compared with repeated doses of CBC in the preservation of donated hearts.