A Direct Comparison Between St Thomas vs Bretschneider Cardioplegic Solution for Minimally Invasive Mitral Valve Surgery
Christoph Krapf, Philip Sommer, Thomas Schachner, Juliane Kilo, Herbert Hangler, Michael Grimm, Ludwig Müller, Nikolaos Bonaros.
Medical University of Innsbruck, Innsbruck, Austria.
OBJECTIVE: Remote access perfusion and transthoracic clamping allow minimally invasive mitral valve surgery (MIMVS) via mini-thoracotomy. There are two main different cardioplegic solutions used for cardioprotection in MIMVS: intermittent administration of St. Thomas’ or single infusion of Bretschneider solution in the aortic root. The aim of the study was to compare perioperative results in terms of cardio- and nephroprotection in patients who underwent MIMVS.
METHODS: From October 2007 till December 2012, 330 patients underwent MIMVS at the Department of Cardiac Surgery Innsbruck. Of them 194 consecutive patients (Log EuroSCORE=4±5) underwent isolated MIMVS, and were divided to a St Thomas (ST) and a Bretschneider (BR) group according to the cardioplegic solution used. Perioperative clinical outcome, as well as laboratory parameters for cardiac and renal injury were retrospectively evaluated.
RESULTS: There was no difference in perioperative mortality (ST: 3/139 vs. BR:0/55, p=0.272) and ICU-stay (ST:33±45 vs. BR:27±19h, p=0.138) between the groups. The incidences of perioperative myocardial infarction (0 vs 0) as well as Risk, Injury, Failure and Loss of the Kidney function according to the RIFLE criteria were also similar (p=0.283). An elaborated investigation of laboratory indicators of myocardial injury revealed increased levels of creatinine phosphokinase (ST:172±975 vs. BR:1104±747 mg/dl, p=0.02) as well as its myocardial isoenzyme (CK-MB ST:89±37 vs BR:48±22, p<0.001) in the ST group. After adjusting for cardiopulmonary bypass and cross clamp time this difference remained evident only for the CK-MB (ST: 80±49 vs 54±27, p=0.01). There was no difference in lactate production or the incidence of renal injury, need for renal replacement therapy or creatinine levels after MIMVS.
CONCLUSIONS: Administration of BR cardioplegia was associated with a clinically non-relevant preservation of myocardial enzyme release after MIMVS.
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