Impact of Histidine-Tryptophan-Ketoglutarate Cardioplegia on Perioperative Prognosis in Surgery Patients for Combined Valvular and Coronary Heart Disease: A Retrospective Study.

Background: Combined valve and coronary surgery is technically complex, and the prognosis for such patients remains poor. This study aimed to analyze the short-term prognostic effects of histidine-tryptophan-ketoglutarate (HTK) cardioplegia versus 1:4 cold blood (CB) cardioplegia in patients requiring combined valve and coronary surgery.

Methods: This retrospective cohort study categorized patients undergoing valve surgery combined with coronary artery bypass grafting (CABG) into two groups: the HTK group (n = 504) and the CB group (n = 188), based on the type of cardioplegia used. Propensity score matching (PSM) was employed to adjust for baseline differences between the groups. The primary endpoints included operative mortality, postoperative myocardial infarction (PMI), postoperative acute kidney injury (AKI), and postoperative atrial fibrillation (POAF). Secondary endpoints included stroke incidence, ventilation time, aortic cross-clamp time, and intensive care unit (ICU) length of stay (LOS).

Results: After PSM, patients with HTK experienced significantly lower rates of AKI and POAF (p < 0.05). Troponin I (TnI) and creatine kinase-MB (CK-MB) measurements at 48 and 72 hours postoperatively were lower in the HTK group compared with the CB group (p < 0.05). However, no significant difference in PMI incidence was detected (p = 0.368). Additionally, the HTK group demonstrated shorter mechanical ventilation times (p = 0.01) and ICU stays (p = 0.009).

Conclusions: HTK cardioplegia reduced postoperative ventilation time, ICU LOS, and the incidence of AKI and POAF compared with CB cardioplegia in patients undergoing valve surgery combined with CABG. HTK cardioplegia is effective, safe, and superior to CB cardioplegia in improving short-term outcomes in these patients.