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Safety of Custodiol for Myocardial Protection in Minimally Invasive Mitral Valve Repair: A Japanese Single-Center

Hiroaki Aizawa1, Akihiro Yoshitake1, Yuki Katsunori2

  • 1Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
|February 23, 2026
PubMed

Insights

Custodiol offers comparable myocardial protection to cold blood cardioplegia in mitral valve repair. This study found lower creatine kinase-MB levels with Custodiol in minimally invasive procedures.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardioplegia Solutions

Background:

  • Limited data exists on Custodiol safety for minimally invasive mitral valve repair in Asian populations.
  • Comparison with traditional open repair methods using cold blood cardioplegia is needed.

Purpose of the Study:

  • To compare the efficacy of Custodiol versus repetitive cold blood cardioplegia.
  • To evaluate myocardial protection in minimally invasive versus open mitral valve repair.

Main Methods:

  • Retrospective analysis of 98 minimally invasive (Custodiol) and 70 open (cold blood cardioplegia) mitral valve repair patients.
  • Primary endpoints: creatine kinase-MB levels and left ventricular ejection fraction (LVEF).
  • Echocardiography used for pre- and post-surgery LVEF assessment.

Main Results:

  • Significantly lower peak creatine kinase-MB levels within 48 hours post-surgery in the minimally invasive group (45.0 U/L) vs. open repair (60.7 U/L; p <0.001).
  • This difference persisted after excluding Maze or PVI procedures (42.4 vs. 50.0 U/L; p = 0.009).
  • Pre- and post-surgery LVEF were comparable between groups (p > 0.20).

Conclusions:

  • Custodiol provides myocardial protection equivalent to repetitive cold blood cardioplegia.
  • Minimally invasive mitral valve repair with Custodiol is a safe and effective alternative.
Abstract

Keywords:
Bretschneider HTK solutionCustodiol cardioplegiaminimally invasive mitral valve repairmyocardial protection

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