Transcript On-pump vs Off-pump CABG surgery: A Single Center Outcome

HTK Cardioprotection in
Ross Procedure for
Native/Prosthetic Valve Endocarditis
Yoshiya Toyoda, Abul Kashem, Aki Shiose,
Kazuhiro Hisamoto, Eros Leotta, Sloane Guy.
Cardiovascular Surgery, Temple University, Philadelphia
BACKGROUND
 Histidine, Tryptophan, a-Ketoglutarate (HTK) solution is a
crystalloid cardioplegia which has intracellular type
composition and high buffer capacity. It has been
reported to provide equivalent myocardial protection to
repetitive dosing of blood cardioplegia. The objective of
this study was to assess HTK cardioprotection during
Ross procedure.
METHODS
 From February to June 2013, three patients underwent
Ross procedures, aortic valve replacement with
pulmonary autograft and pulmonic valve replacement with
pulmonary homograft, with full root technique for native
and prosthetic valve endocarditis.
Prosthetic Valve Infection
RESULTS
 The patient age was 55+/- 3 years (2 male/1 female). The
height was 177+/-6cm, weight 84+/-16kg, BMI 27+/-4.The
preoperative LVEF was 48+/-6%. The preoperative
complications included multiple strokes (n=1), IV drug
abuse (n=2), hemodialysis for failed kidney transplant
with infected arterio-venous fistula (n=1), hepatitis C
(n=1).
 Two patients had prosthetic valve endocarditis of tissue
aortic valves that were placed for native valve
endocarditis 1 and 3 years prior, respectively.
Concomitant procedures included closure of the
ventricular septal defect and tricuspid valve repair (n=1).
RESULTS
 The cardiopulmonary bypass time was 278+/-31 minutes
and the aortic cross-clamp time was 144+/-16 minutes. All
patients were extubated within 2 days. The ICU stay was
4+/-2.6 days and the hospital stay was 10+/-6 days. No
postoperative low output syndrome occurred. The
postoperative LVEF was 53+/-3%. There was no
operative mortality.
CONCLUSION
 HTK cardioprotection can be safely used even for
complex surgery such as Ross procedure. Cardiac
surgery procedure can be simplified because of no need
for repetitive dosing of cardioplegia with excellent
myocardial protection.