© Georg Thieme Verlag Stuttgart · New York
Superior Myocardial Protection with a New Histidine-Buffered Crystalloid Cardioplegic Solution in Clinical Trial
19 March 2008 (online)
Background: Blood cardioplegia has been widely accepted in clinical cardiac surgery based on its excellent oxygen delivery and pH buffering capacity. To further conserve blood during clinical cardiac surgery, we formulated a new crystalloid cardioplegic solution containing histidine (100 mol/L) as the pH buffering agent. Methods: Sixty patients being applied Histidine Buffered Solution (HBS) (n = 27) or Cold Blood Cardioplegic solution (CBC) (n = 33), both at 4 °C, were studied prospectively. Pre- and post-bypass left-ventricular (LV) volume was measured by echocardiography. With a ventricular pressure catheter, LV pressure-volume loops were constructed to determine the slope of the end-systolic pressure-volume relationship (Emax) without inotropes. Results: There were no postoperative deaths in either group. Thirty minutes after reperfusion Emax was significantly better in the HBS group than in the CBC group (6.0±1.0 mmHg/cm3 vs 3.7±0.8 mmHg/cm3). Cardiac Index was also significantly higher in HBS group than in CBC group with lower inotropic requirement. Homologous blood transfusion was avoided in 64% of the patients receiving HBS versus 48% of the patients with CBC. Conclusions: We conclude that the new histidine-buffered cardioplegic solution provides effective protection with excellent recovery of pump performance in clinical open heart surgery.
Cold blood cardioplegia - Crystalloid cardioplegic solution - Histidine - Open heart surgery - Clinical trial