International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive Mitral Valve Surgery Using Htk Solution Vs Blood Cardioplegia; A Retrospective Comparison In 581 Patients
David Heimansohn, Peter Walts, Chris Salerno, Sina Moainie, Karen Roberts, Meghan Honerlaw-Tooman, Anita Fries.
St. Vincent Heart Center of Indiana, Indianapolis, IN, USA.

Background: The purpose of this 10-year retrospective study is to compare the safety and efficacy of conventional cold blood Cardioplegia (CBC) vs HTK crystalloid cardioplegia (CC) as a myocardial protection strategy during minimally invasive mitral valve (MV) surgery.METHODS: We retrospectively evaluated 581 patients (mean age 64 years) who underwent minimally invasive mitral valve surgery via a right mini-thoracotomy approach between January 2008 and May 2017. Myocardial protection was administered as either CBC (n=218) or CC (n=363). The groups were evenly matched by gender and preoperative demographics. 318 patients had an isolated mitral valve repair (MVP), 71 had a mitral valve replacement (MVR), and 192 patients had an MVP or MVR with a concomitant procedure (atrial septal defect, tricuspid valve replacement, or a MAZE). RESULTS: Cardiopulmonary bypass and cross-clamp times were both significantly shorter in the CC group compared to the CBC group (133 minutes vs 148 minutes, and 109 minutes vs 92 minutes respectively). No significant differences in operative mortality and 30 day mortality were observed. CKMB values were significantly lower in the CC group compared to the CBC group (63mg/dl vs 95 mg/dl). Postoperative morbidity measures including renal failure, prolonged ventilation, creatinine change, all were equal or improved in the CC group. Hospital length of stay was reduced in the CC group (6.5 days) compared to the CBC group (7.5 days). CONCLUSION: Crystalloid HTK cardioplegia solution is safe and effective for myocardial protection during minimally invasive mitral valve surgery as compared to conventional blood cardioplegia. In addition, HTK cardioplegia may contribute to shorter cross-clamp and pump times, which resulted in less morbidity and a reduced hospital length of stay in this patient cohort.

Patient Outcomes
Blood CardioplegiaBlood CardioplegiaHTK CardioplegiaHTK Cardioplegia
NMean (SD) or %NMean (SD) or %p-value
Lengthof Stay(Days)2187.9 (3.9)3636.5 (3.8)<0.0001
Renal failure2181.43630.60.3498
Creatinine change (mg/dl)2180.28 (0.63)3630.07 (0.36)<0.0001
Hospital Mortality2180.53631.10.3688
30 day mortality1311.53151.60.9627
BypassTime (min)218147.8 (49.7)363132.5 (38.3)<0.0001
Cross-clamp Time (min)218109.3 (37.7)36392.1 (26.6)<0.0001
CKMB mean21094.6 (96.9)36263.3 (79.8)<0.0001


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