Early Outcomes Of Del Nido Microplegia In Minimally Invasive Mitral Valve Repair: A Single Institution Experience
Elan A. Sherazee, Amir A. Sarkeshik, Anna H. Xue, Paul Perry, Sabrina A. Evans, J Nilas Young, Victor M. Rodriguez, Bob Kiaii.
UC Davis Medical Center, Sacramento, CA, USA.
BACKGROUND: Few studies have reported outcomes of whole blood Del Nido Microplegia (DNM) in minimally invasive cardiac surgery (MICS). Our institution recently began a MICS program in which we utilize DNM, a whole blood cardioplegia with Del Nido additives. We sought to compare early clinical outcomes of minimally invasive mitral valve repair with DNM to traditional mitral valve repair with crystalloid (Del Nido or Custodiol) cardioplegia solution.
METHODS: Following IRB approval, patients aged ≥18 years who underwent either minimally invasive mitral valve repair or open mitral valve repair were identified for this retrospective study. Clinicodemographic and perioperative outcomes were analyzed using parametric and non-parametric tests where appropriate.
RESULTS: Between October 2018 and September 2021, 40 patients underwent either minimally invasive mitral valve repair with DNM (n=20) or open mitral valve repair with crystalloid cardioplegia (Del Nido n=16, Custodiol n=4). Preoperative characteristics were similar between groups. The median age was 62 years (range 30-78), 85% (n=34) were men and. The STS perioperative 30-day mortality for the MICS cohort was slightly lower (0.4% vs. 0.7%, P<0.05). Compared to the open group, the MICS group had significantly longer CPB time (247 ± 35min vs. 157 ± 38min, P<0.01), XC time (145 ± 31min vs. 107 ± 28min, P<0.01), cardioplegia volume (2095 ± 775mL vs. 1581 ± 532mL, P<0.05). There was no difference in intraoperative PRBC use. Clinically, there were no differences in clinical outcomes such as 30-day mortality, hospital LOS, time to extubation, change in ejection fraction between pre-op and post-op, incidence of post-op atrial fibrillation or the need for inotropes to wean from CPB.
CONCLUSIONS: Operative time for minimally invasive mitral valve repair with DNM is longer and requires more bypass time, cross clamp time and extended myocardial protection. Despite these differences, early outcomes using whole blood DNM during minimally invasive mitral valve repair are comparable to traditional, open techniques with similar early outcomes and 30-day mortality. These short-term results are encouraging, suggesting DNM provides adequate myocardial protection despite longer cardiac arrest times often required for MICS. A larger sample size, with long term follow up, is necessary to document further efficacity.
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