Minimally invasive mitral valve surgery using single dose antegrade Custodiol cardioplegia.
OBJECTIVE
Our unit began a minimally invasive mitral surgery (MIMS) program utilising antegrade Custodiol solution as the sole cardioplegia. The aim of this paper is to report our results of this program.


METHODS
Early clinical outcomes were identified and assessed for the first consecutive 100 MIMS patients with comparisons made to a historical group operated via a sternotomy (n=113). The efficacy of myocardial protection was assessed using surrogate outcomes of myocardial protection with serial sodium concentrations also analysed.


RESULTS
Six hours postoperatively 12 patients required inotropic support. Peak troponin-I in the first 24 hours was 5.1 (0.8-40 μg/L [median(range)]. Sodium levels decreased following administration of Custodiol but by six hours postoperatively the sodium had returned to greater than 130 mmol/L in all but five patients. Blood transfusion was smaller in the MIMS versus historical group (RBC 17% vs. 65%). MIMS patients had a shorter duration of ventilation, hospital stay and one-year mortality rate (0%).


CONCLUSIONS
In this series of patients undergoing MIMS, single dose antegrade Custodiol offers satisfactory and safe myocardial protection. Early clinical outcomes were also satisfactory. Whilst our findings are observational, they nevertheless support the use of this less invasive approach to mitral surgery using single dose Custodiol for myocardial protection.
Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia. Electronic address: shannon.matzelle@uwa.edu.au.
Shannon J
SJ
Matzelle
Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia.
Michelle J
MJ
Murphy
Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia.
William M
WM
Weightman
Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia.
Neville M
NM
Gibbs
Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia.
J James B
JJ
Edelman
Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia; School of Medicine, Fremantle, University of Notre Dame, Western Australia.
Jurgen
J
Passage
D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006324:Heart Arrest, Induced / Q000379:methods*; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D008943:Mitral Valve / Q000601:surgery*; D011182:Postoperative Care; D011189:Potassium Chloride / Q000008:administration & dosage; D011343:Procaine / Q000008:administration & dosage; D012964:Sodium / Q000097:blood; D056346:Sternotomy / Q000009:adverse effects; D019210:Troponin I / Q000097:blood
C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D002316:Cardiotonic Agents; D019210:Troponin I; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D012964:Sodium; D005947:Glucose
CPB; Cardiopulmonary bypass; Minimally invasive surgery; Mitral valve repair; Mitral valve replacement; Myocardial protection/cardioplegia