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Published on: March 26, 2018
Myocardial protection during minimally invasive cardiac surgery through right mini-thoracotomy
Micaela De Palo1, Pietro Guida1, Florinda Mastro1
1Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.
Insights
Cold blood and Custodiol cardioplegia show similar myocardial protection during minimally invasive cardiac surgery (MICS). This study compared outcomes, finding no significant differences in myocardial injury or patient recovery between the two methods in MICS procedures.
Area of Science:
- Cardiovascular Surgery
- Cardioplegia Techniques
- Minimally Invasive Cardiac Surgery (MICS)
Background:
- Myocardial damage is a key predictor of adverse outcomes in cardiac surgery.
- Custodiol cardioplegia is widely used in MICS, but comparative data with blood cardioplegia is lacking for this approach.
- Effective myocardial protection is crucial for successful cardiac surgery outcomes.
Purpose of the Study:
- To compare the efficacy of cold blood cardioplegia versus Custodiol cardioplegia in MICS.
- To evaluate myocardial protection strategies in minimally invasive cardiac surgery.
- To assess clinical outcomes associated with different cardioplegia solutions in MICS.
Main Methods:
- Retrospective evaluation of 90 patients undergoing MICS via right mini-thoracotomy.
- Patients received either cold blood (CBC) or Custodiol cardioplegia.
- Primary outcomes included post-operative cardiac troponin I (cTnI) and CKMB release, and Low Cardiac Output Syndrome (LCOS) incidence.
Main Results:
- Aortic cross-clamp and cardiopulmonary bypass times were longer in the Custodiol group.
- No significant differences were observed in myocardial injury markers (peak cTnI, CKMB).
- Mortality, LCOS, arrhythmias, transfusion needs, ventilation duration, and hospital stay were similar between groups.
Conclusions:
- Both Custodiol and cold blood cardioplegia provide comparable myocardial protection in MICS.
- The choice between Custodiol and cold blood cardioplegia does not appear to impact key clinical outcomes in right mini-thoracotomy MICS.
- Further research may explore optimal cardioplegia strategies for specific MICS procedures.
Background:
Myocardial damage is an independent predictor of adverse outcome following cardiac surgery and myocardial protection is one of the key factors to achieve successful outcomes. Cardioplegia with Custodiol is currently the most used cardioplegia during minimally invasive cardiac surgery (MICS). Different randomized controlled trials compared blood and Custodiol cardioplegia in the context of traditional cardiac surgery. No data are available for MICS.
Aim:
The aim of this study was to compare the efficacy of cold blood versus Custodiol cardioplegia during MICS.
Method:
We retrospectively evaluated 90 patients undergoing MICS through a right mini-thoracotomy in a three-year period. Myocardial protection was performed using cold blood (44 patients, CBC group) or Custodiol (46 patients, Custodiol group) cardioplegia, based on surgeon preference and complexity of surgery.
Results:
The primary outcomes were post-operative cardiac troponin I (cTnI) and creatine kinase MB (CKMB) serum release and the incidence of Low Cardiac Output Syndrome (LCOS). Aortic cross-clamp and cardiopulmonary bypass times were higher in the Custodiol group. No difference was observed in myocardial injury enzyme release (peak cTnI value was 18±46 ng/ml in CBC and 21±37 ng/ml in Custodiol; p=0.245). No differences were observed for mortality, LCOS, atrial or ventricular arrhythmias onset, transfusions, mechanical ventilation time duration, intensive care unit and total hospital stay.
Conclusions:
Custodiol and cold blood cardioplegic solutions seem to assure similar myocardial protection in patients undergoing cardiac surgery through a right mini-thoracotomy approach.
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