Late Efficacy Of Histidine-Tryptophan-Ketoglutarate, Del Nido And St. Thomas Protocols In Minimally Invasive Mitral Surgery
Steve Singh1, Kevin McCusker2, Serdar Gunaydin3.
1Brigham & Women's Hospital, Boston, MA, USA, 2New York Medical College, New York, NY, USA, 3Numune Training & Research Hospital, Ankara, Turkey.
Background: Single dose cardioplegic techniques offer comfortable conditions for lengthy valve surgery but extending the adjunct myocardial preservation further is a major question. Different randomized controlled trials examined comparison to conventional techniques in the context of traditional cardiac surgery with no specific data being available for minimally invasive techniques.Our aim was to compare the long-term protective effects of different cardioplegia formulas based on early and 30-day clinical outcome via thorough continuous monitoring. Methods: This prospective cohort study included high-risk patients (Euroscore II >5) undergoing minimally invasive mitral valve surgery who received different cardioplegic solutions between January 2015 and December2017. Patients were matched for age, gender, BMI, valve size and type, STS score, surgical access, pre-op creatinine, diabetes, and COPD : Group 1: St. Thomas- N=43; Group 2: Del Nido- N=49; Group 3: HTK- N=44. Patients were monitored perioperatively by memory loop recording (MLR) and auto-triggered MLR for 30 days via documentation of predefined symptomatic and asymptomatic events. Results: Early perioperative data demonstrated that all four types or cardioplegia techniques provided effective clinical outcome with no difference in myocardial injury enzyme release (peak cTnI value; p=0.218). No significant differences were observed for mortality, LOS, onset of atrial or ventricular arrhythmias, transfusions, mechanical ventilation time duration, intensive care unit and total hospital stay. Long-term telemetry monitoring with respect to arrhythmia detection and diagnostic symptoms are summarized in Figure (*:p<0.01). Conclusions: Myocardial preservation is a concept without clear and specific clinical signs. Especially long-term outcomes have not been studied in details during minimally invasive cardiac surgery. Our data underlines the importance of long-term efficacy of cardioplegic techniques which becomes more prominent in high-risk patients who have truly a chance to benefit from adjunct cardioprotection.
LEGEND: Figure: Perioperative 30-day follow-up of patients
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