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OBJECTIVE: In minimally invasive cardiac surgery (MICS) via a right minithoracotomy approach, myocardial protection is relatively challenging because of technically demanding retrograde cardioplegia or troublesome changes of the mitral valve exposure for antegrade cardioplegia. Crystalloid intracellular-type cardioplegia is advantageous to decrease frequency of cardioplegia delivery in cardiac surgery. We aimed to investigate efficacy of crystalloid intracellular-type cardioplegia in MICS.
METHODS: We retrospectively reviewed 42 MICSs performed from December 2011 to November 2013 and compared the outcomes of patients undergoing MICS using crystalloid intracellular-type cardioplegia (Group CR; n=26) with those who had blood cardioplegia (Group BL; n=16). Both cardioplegias were delivered by antegradely through the aortic root cannula as cold solution. Selection of cardioplegia depended on surgeons’ preference. Warm terminal cardioplegia was given in group BL.
RESULTS: Group CR included 25 mitral valve surgeries and 1 atrial septal defect closures while Group BL included 12 mitral valve surgeries, 1 atrial septal defect closure and 3 left atrial tumor resections. The baseline characteristics were similar between the groups. Cardiac arrest time was significantly longer in group CR (126 min versus 107 min (p=0.041). The mean volume of cardioplegia was smaller in group CR (2035 ml versus 6803 ml (p<0.001)). The mean frequency of cardioplegia delivery was fewer in group CR (1.1 versus 4.0 (p<0.001)). 25 patients (96%) in group CR needed only 1 delivery of cardioplegia. No hospital mortality was observed in either group. The mean intubation time and postoperative creatine kinase MB was similar in both groups (18.9 hours versus 19.1 hours, and 30.1 ng/ml versus 37.1 ng/ml, respectively). There was 1 right ventricular failure in group BL. This might be related to myocardial protection.
CONCLUSIONS: Crystalloid intracellular-type cardioplegia was efficient and helpful to simplify management of myocardial protection, to minimize the procedural time, and consequently, to improve the safety of MICS.