title: Safety of single-dose histidine-tryptophan-ketoglutarate cardioplegia during minimally invasive mitral valve surgery.
abstract: OBJECTIVE
  Minimally invasive mitral valve surgery may require a prolonged period of myocardial ischemia. Cardioplegic solutions that necessitate a single dose for adequate myocardial protection are evoked to simplify surgery and result to be appealing in this setting. The aim of this study was to assess early outcomes after minimally invasive mitral valve surgery using one single dose of histidine-tryptophan-ketoglutarate solution (HTK; Custodiol) for myocardial protection.
  
  
  METHODS
  Between February 2003 and October 2012, a total of 49 consecutive patients underwent minimally invasive mitral valve surgery using a single dose of HTK solution for myocardial protection. The patients' mean (SD) age was 57 (14) years; the preoperative ejection fraction was normal in all cases. The mean (SD) CPB time and aortic cross-clamp time were 148 (45) minutes and 97 (45) minutes, respectively.
  
  
  RESULTS
  The heart spontaneously restarted after cross-clamp removal in 37 patients (75.5%). Five patients (10.2%) required prolonged inotropic drug support. Postoperatively, no significant increase in myocardial cytonecrosis enzymes was found [mean (SD) creatine kinase isoenzyme MB, 77.14 (53.67) μg/L at 3 hours, 71.2 (55.67) μg/L at 12 hours, and 42.53 (38.38) μg/L at 24 hours)], and no ischemic electrocardiogram modifications were observed before discharge.
  
  
  CONCLUSIONS
  During minimally invasive mitral valve surgery, HTK solution provided excellent myocardial protection even after prolonged periods of cardioplegic arrest. The avoidance of repetitive infusions may reduce the risk for coronary malperfusion due to dislodgement of the endoaortic clamp (if used) and increase the surgeon's comfort during the procedure.
authors.affiliation: From the Departments of *Cardiac Surgery, and †Anesthesia and Resuscitation, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Savini
authors.forename: Giacomo
authors.initials: G
authors.lastname: Murana
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.forename: Sofia Martin
authors.initials: SM
authors.lastname: Suarez
authors.forename: Giuliano
authors.initials: G
authors.lastname: Jafrancesco
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Castrovinci
authors.forename: Andrea
authors.initials: A
authors.lastname: Castelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006324:Heart Arrest, Induced; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000601:surgery; D017202:Myocardial Ischemia / Q000517:prevention & control; D011189:Potassium Chloride / Q000008:administration & dosage; D011343:Procaine / Q000008:administration & dosage; D012189:Retrospective Studies
chemical_list: C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D002316:Cardiotonic Agents; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D052279:Creatine Kinase, MB Form; D005947:Glucose