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One single antegrade dose of cold HTK cardioplegia is a safe and easy cardioprotective strategy in minimally invasive mitral valve surgery
Carlo Savini, Sr., Giacomo Murana, Marco Di Eusanio, Sofia Martin Suarez, Sebastiano Castrovinci, Giuliano Jafrancesco, Andrea Castelli, Roberto Di Bartolomeo.
Ospedale S.Orsola-Malpighi, Bologna, Italy.

OBJECTIVE: Minimally invasive cardiac surgery (MICS) sometimes can be technically demanding, especially during some mitral valve surgical procedure. Particularly in these situations, a single-dose cardioplegia seems attractive especially when an endoaortic clamp is used. We retrospectively analyzed our early outcomes using one single dose of histidine-triptophane-ketoglutarate (HTK-Custodiol) solution for myocardial protection in minimally invasive mitral valve surgery.
METHODS: From February 2003 to October 2012, 49 consecutive patients underwent minimally invasive mitral valve surgery using an endo-cardiopulmonary bypass (CPB) system and a single dose of HTK solution as myocardial protection. The mean patient age was 61.1 ± 9.3 years, and the preoperative ejection fraction was normal in all patients. Mean CPB time was 142.2 ± 21.4 minutes, and aortic cross-clamp duration was 92.5 ± 16.2 minutes.
RESULTS: The heart restarted spontaneously after cross-clamp removal in 37 patients (75,5%). Only 7 (14,3%) patients needed inotropic drug support after CPB discharge, and none patients required intraoperative anti-arrhythmic infusion. No significant modifications in myocardial cytonecrosis enzymes during the postoperative period was found (Mean CK-MB 75.5 ± 4.2 μg/L at 6h, 63.7 ± 4.7 μg/L at 12 h, and 48.2 ± 3.8 μg/L at 24h). There was no ischemic ECG modification in all patients (100%) prior to Hospital discharge.
CONCLUSIONS: HTK solution allows excellent myocardial protection and a safe long cardioplegic arrest time during elective and urgent minimally invasive mitral valve surgery. It also reduces the risk of inadequate coronary perfusion due to dislodgement of the endoaortic clamp, and increases the comfort of the surgeon during the procedure. Further randomized studies will be needed to demonstrate its effectiveness compared to repeated blood cardioplegia infusion.


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