Selim KUŞÇU, Aynur CAMKIRAN FIRAT, Pınar ZEYNELOLU, Arash PİRAT, MURAT ÖZKAN, Gülnaz ARSLAN

PEDİYATRİK KARDİYAK CERRAHİDE HİSTİDİN-TRİPTOFAN-KETOGLUTARAT VE GELENEKSEL KRİSTALLOİD KARDİYOPLEJİ SOLÜSYONLARININ MİYOKARDİYAL KORUMA ÜZERİNE ETKİLERİNİN KARŞILAŞTIRILMASI

Bu çalışma ile pediyatrik kalp cerrahisinde kullanılan Histidin-Triptofan-Ketoglutarat (HTK) ve geleneksel kristalloid kardiyoplejisolüsyonlarının perioperatif miyokardiyal korumanın göstergelerinden kardiyak troponin-I (cTn-I) ve kreatinkinaz miyokardiyal band (CK-MB)salıverilmesi üzerine olan etkilerinin karşılaştırılması amaçlanmıştır.Yöntem: Elektif konjenital kalp cerrahisi yapılacak olan 1ay-6 yaş arası 66 çocuk rastgele iki gruba ayrıldı. Aort klempi sonrası kardiyoplejisolüsyonu olarak HTK solüsyonu (Grup H, n=32) veya kristalloid kardiyopleji (Grup K, n=34) verildi. cTn-I ve CK-MB düzeyleri için kan örnekleriinsizyon yapılmadan önce, cerrahi bitiminde ve postoperatif 4, 16, 24 ve 48. saatlerde alındı. Hastaların intraoperatif ve postoperatif inotrop ilaçgereksinimleri, kullanılan kan ürünü ve sıvı miktarı, idrar çıktıları, hemodinamik parametreleri ile postoperatif mekanik ventilasyon, yoğun bakımve hastanede kalış süreleri kaydedildi.Bulgular: Her iki grupta hastaların demografik özellikleri benzerdi. Gruplar arasında operasyon süreleri, aort klemp süreleri ve kardiyopulmoner"bypass" (KPB) süreleri, intraoperatif kullanılan sıvı miktarları ve idrar çıktıları benzer olarak saptandı. Cerrahi girişim sonu ve postoperatifdönemde cTn-I ve CK-MB değerleri açısından gruplar arasında farklılık saptanmadı (p>0.05). Mekanik ventilasyon, yoğun bakım ve hastanedekalış süreleri de iki grup için benzerdi (p>0.05).Sonuç: Pediyatrik kalp cerrahisinde kullanılan HTK ve kristalloid kardiyopleji solüsyonlarının miyokardiyal korumada birbirlerine üstünolmadığı saptandı. HTK'nın pediyatrik hastalarda miyokardiyal koruma üstüne olan etkilerini daha iyi anlamak için kompleks pediyatrik kalpcerrahisi girişimlerini içeren geniş kapsamlı çalışmalara gereksinim vardır

A COMPARISON OF THE EFFECTS OF HISTIDIN-TRYPRTOPHAN-KETOGLUTARATE AND CONVENTIONAL CRYSTALLOID CARDIOPLEGIA SOLUTIONS ON MYOCARDIAL PROTECTION DURING PEDIATRIC CARDIAC SURGERY

The aim of this study is to compare the effects of Histidin-Tryprtophan-Ketoglutarate and conventional crystalloid cardioplegia onrelease of cardiac troponin-I (cTn-I) and creatinekinase-myocardial band (CK-MB) which are perioperative determinants of myocardial protection.Method: Sixty-six children aged 1 month to 6 years undergoing elective congenital heart surgery were randomised into two groups. Afteraortic cross-clamping the groups receieved HTK solution (Group H, n=32) or crystalloid cardioplegia (Group K, n=34) for cardioplegic induction.Blood samples for cTn-I and CK-MB levels were measured before the surgical incision, at the end of surgery and on 4th, 16th, 24thand 48thhourspostoperatively. Patients' intraoperative and postoperative maximum inotropic drug requirements, amounts of blood and fluids used, urine output,hemodynamic parameters, levels of cTn-I and CK-MB and duration of mechanical ventilation, lengths of intensive care unit (ICU) and hospitalstay were recorded.Results: Demographic features were similar in both groups. Duration of surgery, aortic clamp and cardiopulmonary bypass (CPB) times,amounts of intraoperative fluids used and urine outputs were similar between the groups. The groups were not significantly different in terms ofcTn-I and CK-MB levels at the end of surgery and postoperative period (p>0.05 forall). Duration of mechanical ventilation, lengths of ICU andhospital stay were similar in both groups (p>0.05 for all).Conclusion: HTK and crystalloid cardioplegia solutions are not superior to the other for myocardial protection during pediatric cardiacsurgery. Larger studies including complex pediatric cardiac surgeries are needed to better understand the effects of HTK solution on myocardialprotection in pediatric patients

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