HTK Cardioprotection in Ross Procedure for Native/Prosthetic Valve Endocarditis Yoshiya Toyoda, Abul Kashem, Aki Shiose, Kazuhiro Hisamoto, Eros Leotta,

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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,  -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.