Document Type

Article

Publication Date

4-30-2025

Abstract

Background/Introduction: Cardioplegia solutions are integral to myocardial protection during cardiac surgery, particularly during ischemic periods induced by cardiopulmonary bypass (CPB). Histidine-Tryptophan-Ketoglutarate (HTK) solution and potassium-based solutions such as Del Nido, St. Thomas, 4:1, and Microplegia are widely utilized for their distinct biochemical mechanisms and protective properties. Despite their widespread application, variability in clinical outcomes and procedural contexts has led to uncertainty about the optimal choice of cardioplegia solution. This scoping review aims to compare HTK and potassium-based solutions, focusing on their efficacy, postoperative outcomes, and complications in adult patients undergoing coronary artery bypass graft (CABG) and valve surgeries, including minimally invasive approaches.

Methodology: This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched for studies published between 2017 and 2024 that compared HTK and potassium-based cardioplegia solutions in adult cardiac surgeries. Eligibility criteria included original, full-text English-language studies involving CABG or valve procedures performed on CPB. Exclusion criteria included pediatric studies, cell-based research, and review articles. Relevant data were charted and synthesized into narrative and tabular formats, highlighting trends, gaps, and comparative insights.

Results: The search yielded 12 studies comprising randomized controlled trials, prospective observational studies, and retrospective analyses. HTK and potassium-based solutions demonstrated comparable myocardial protection across most procedures, as evidenced by similar postoperative cardiac enzyme levels. Del Nido exhibited superior efficiency in procedures with shorter ischemic times, while HTK offered advantages in reducing atrial fibrillation and hospital readmissions. Both solutions showed comparable rates of mortality and morbidity. Secondary outcomes revealed nuanced differences, such as lower acute kidney injury rates with Del Nido and longer CPB times associated with HTK.

Discussion/Conclusions: Both HTK and potassium-based solutions effectively provide myocardial protection and achieve comparable primary outcomes in cardiac surgeries. However, their differences in secondary outcomes, including recovery times, inflammatory responses, and renal impacts, suggest that the choice of cardioplegia solution should be tailored to patient-specific factors and surgical contexts. These findings underscore the need for further randomized controlled trials and standardized protocols to refine cardioplegia strategies and improve outcomes.

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