Comparative Effects Of Single-dose Cardioplegic Solutions In Especially Repeated Doses During Minimally Invasive Aortic Valve Surgery?
Serdar Gunaydin1, Kevin McCusker2.
1City Hospital, Ankara, Turkey, 2New York Medical College, New York, NY, USA.
Background: Despite the popularity of single-dose cardioplegic techniques especially in minimally invasive surgery, the impact of hemodilution and time window for satisfactory protection especially in repeated doses still remain unclear. This study aims to compare hemodilution, transfusion requirements and aquaporine (AQP)/endothelial glycocalyx(EG) expression in patients undergoing surgery with either Del Nido or HTK cardioplegia. Methods: This prospective study included patients undergoing minimally invasive aortic valve surgery with different cardioplegic solutions between January 2018 and May 2019. Patients (N=60 in each group) were matched for age, gender, cross clamp time, BMI and STS score: Group 1 (Del Nido-single dose), Group 2 (HTK, single dose), Control (St Thomas-every 20 min). Data of patients who received repeated doses of Del Nido (N=17) and HTK (N=15) were further analyzed. The expression of AQP-1 was analyzed using quantitative real-time PCR and EG via syndecan-1 (coronary sinus samples before and after CPB) by ELISA.Results: The total volume of administered cardioplegic solution was 1950±50 mL for Del Nido, 2050±50 mL for HTK and 2100±50 mL for control. Perioperative data is summarized in Table 1. Syndecan-1 and AQP-1 levels are demonstrated in Fig 1. The subgroup of patients who received Del Nido/repeated had significantly more transfusion, low cardiac output, as well as worse myocardial integrity (EG shedding) and less response to osmotic overload (AQP expression) versus control. Repeated doses significantly reduced AQP1 intensity in Del Nido/repeated group. Conclusions:Single-dose cardioplegic solutions don’t have any deleterious impact on hemodilution/transfusion related to the volume administered by using appropriate CPB techniques and ultrafiltration. But repeated doses may increase osmotic pressure to a level of cellular decompensation especially in Del Nido formulation which may lead endothelial destruction and associated worse clinical outcomes. 
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