Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management.
10.1097/CM9.0000000000001643
- VernacularTitle:Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management
- Author:
Li-Ting BAI
1
;
Yuan-Yuan TONG
2
;
Jin-Ping LIU
1
;
Zheng-Yi FENG
1
;
Ju ZHAO
1
;
Sheng-Wen GUO
1
;
Yu JIN
1
;
Pei-Yao ZHANG
1
;
Yi-Xuan LI
1
Author Information
1. Department of Cardiopulmonary Bypass, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
2. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
- Publication Type:Journal Article
- MeSH:
Glucose/therapeutic use*;
Histidine;
Humans;
Infant, Newborn;
Mannitol;
Organ Preservation Solutions;
Potassium Chloride/therapeutic use*;
Prognosis;
Retrospective Studies;
Stroke Volume;
Tryptophan;
Ventricular Function, Left
- From:
Chinese Medical Journal
2021;134(24):2968-2975
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Histidine-tryptophan-ketoglutarate (HTK) is a solution commonly used for organ transplantation. However, there is no certified fixed regimen for on-pump heart surgery in neonates. We aimed to retrospectively evaluate the outcomes related to different HTK dosages and to analyze the safety of high-dosage perfusion.
METHODS:A total of 146 neonates who underwent on-pump heart surgery with single-shot HTK perfusion were divided into two groups according to HTK dosages: a standard-dose (SD) group (n = 63, 40 mL/kg < HTK ≤ 60 mL/kg) and a high-dose (HD) group (n = 83, HTK >60 mL/kg). Propensity score matching (PSM) was performed to control confounding bias.
RESULTS:The SD group had a higher weight (3.7 ± 0.4 vs. 3.4 ± 0.4 kg, P < 0.0001), a lower proportion of complete transposition of the great artery (69.8% vs. 85.5%, P = 0.022), a lower cardiopulmonary bypass (CPB) time (123.5 [108.0, 136.0] vs. 132.5 [114.8, 152.5] min, P = 0.034), and a lower aortic x-clamp time (82.9 ± 27.1 vs. 95.5 ± 26.0 min, P = 0.005). After PSM, 44 patients were assigned to each group; baseline characteristics and CPB parameters between the two groups were comparable. There were no significant differences in peri-CPB blood product consumption after PSM (P > 0.05). The incidences of post-operative complications were not significantly different between the two groups. There were no significant differences in ventilation time, intensive care unit stay, and post-operative hospital stay (P > 0.05). Follow-up echocardiography outcomes at 1 month, 3 to 6 months, and 1 year showed that left ventricular ejection fraction and end-diastolic dimension were comparable between the two groups.
CONCLUSIONS:In neonatal on-pump cardiac surgery patients, single-shot HD (>60 mL/kg) HTK perfusion had a comparable heart protection effect and short-term post-operative prognosis as standard dosage perfusion of 40 to 60 mL/kg. Thus, this study provides supporting evidence of the safety of HD HTK perfusion.
