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Ann Thorac Surg 1997;64:59-63
© 1997 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Clinical Assessment of Prolonged Myocardial Preservation for Patients With a Severely Dilated Heart

Mitsuhiro Hachida, MD, Masaki Nonoyama, MD, Yukihiro Bonkohara, MD, Naoji Hanayama, MD, Satoshi Saitou, MD, Tomohiro Maeda, MD, Akihiko Ohkado, MD, Hua Lu, MD, Hitoshi Koyanagi, MD

Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical College, Tokyo, Japan

Accepted for publication January 4, 1997.

Background. The purpose of this study was to compare the myocardial protective effect of histidine-tryptophan-potassium and glucose-insulin-potassium cardioplegic solutions in patients with a dilated heart (left ventricular diastolic diameter > 55 mm, left ventricular systolic diameter > 45 mm) associated with prolonged cross-clamp time (longer than 200 minutes).

Methods. We selected 20 patients with dilated hearts due to severe aortic regurgitation. Glucose-insulin-potassium cardioplegia was used in 11 patients and histidine-tryptophan-potassium cardioplegia was used in 9 patients.

Results. After operation, the cardiac index was significantly increased in the histidine-tryptophan-potassium group (p < 0.05). Postoperative percent fractional shortening was 13.4% ± 3.1% in the glucose-insulin-potassium group and 23.6% ± 2.6% in the histidine-tryptophan-potassium group (p < 0.05). Creatine kinase levels were significantly lower in the histidine-tryptophan-potassium group than that in the glucose-insulin-potassium group (p < 0.05). The incidence of ventricular arrhythmia (higher than Lown's grade 2) was lower in the histidine-tryptophan-potassium group.

Conclusions. These data support the superiority of the histidine-tryptophan-potassium method over the glucose-insulin-potassium method for protection of the dilated heart during prolonged ischemia in open heart operations.




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