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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Single-Dose St. Thomas Versus Custodiol® Cardioplegia for Right Mini-thoracotomy Mitral Valve Surgery

Cristina Barbero1, Marco Pocar2,3,4, Giovanni Marchetto2

  • 1Cardiovascular and Thoracic Department, Division of Cardiac Surgery, , Città Della Salute E Della Scienza", University of Turin, Corso Dogliotti, 14, Turin, Italy. cristina.barbero@unito.it.

Journal of Cardiovascular Translational Research
|August 8, 2022
PubMed

Insights

Single-dose St. Thomas cardioplegia offers effective myocardial protection for over an hour in minimally invasive mitral valve surgery. This approach is a safe alternative to Custodiol® cardioplegia.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia
  • Cardioplegia Solutions

Background:

  • Custodiol® and St. Thomas cardioplegia are standard for minimally invasive mitral valve surgery.
  • Custodiol® provides 3 hours of protection; St. Thomas typically requires reinfusion every 30 minutes.
  • The safety and efficacy of a single dose of St. Thomas cardioplegia are not well-established.

Purpose of the Study:

  • To compare the efficacy and safety of single-shot St. Thomas cardioplegia versus Custodiol® cardioplegia.
  • To evaluate myocardial protection during mini-thoracotomy mitral valve operations.

Main Methods:

  • Prospective observational study comparing 39 patients receiving St. Thomas with 25 patients receiving Custodiol®.
  • Primary endpoint: cardiac troponin T levels post-operatively.
  • Propensity-weighted treatment to adjust for confounding factors; cross-clamping time exceeded 45 minutes.

Main Results:

  • No significant differences in postoperative myocardial injury markers between the two cardioplegia solutions.
  • Ventricular fibrillation upon resumption of electrical activity was more frequent with Custodiol® (P=.01).

Conclusions:

  • Single-dose St. Thomas cardioplegia can provide effective myocardial protection exceeding 1 hour.
  • It is a viable option for selected patients undergoing right mini-thoracotomy mitral valve surgery.
Abstract

Keywords:
Cardiopulmonary bypassCrystalloid cardioplegiaMinimally invasive surgeryMitral valve repairMyocardial protection

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