title: Myocardial Protection and Financial Considerations of Custodiol Cardioplegia in Minimally Invasive and Open Valve Surgery.
abstract: OBJECTIVE
  Single-dose antegrade crystalloid cardioplegia with Custodiol-HTK (histidine-tryptophan-ketoglutarate) has been used for many years. Its safety and efficacy were established in experimental and clinical studies. It is beneficial in complex valve surgery because it provides a long period of myocardial protection with a single dose. Thus, valve procedures (minimally invasive or open) can be performed with limited interruption. The aim of this study is to compare the use of Custodiol-HTK cardioplegia with traditional blood cardioplegia in patients undergoing minimally invasive and open valve surgery.
  
  
  METHODS
  A single-institution, retrospective case-control review was performed on patients who underwent valve surgery in Lee Memorial Health System at either HealthPark Medical Center or Gulf Coast Medical Center from July 1, 2011, through March 7, 2015. A total of 181 valve cases (aortic or mitral) performed using Custodiol-HTK cardioplegia were compared with 181 cases performed with traditional blood cardioplegia. Each group had an equal distribution of minimally invasive and open valve cases. Right chest thoracotomy or partial sternotomy was performed on minimally invasive valve cases. Demographics, perioperative data, clinical outcomes, and financial data were collected and analyzed.
  
  
  RESULTS
  Patient outcomes were superior in the Custodiol-HTK cardioplegia group for blood transfusion, stroke, and hospital readmission within 30 days (P < 0.05). No statistical differences were observed in the other outcomes categories. Hospital charges were reduced on average by $3013 per patient when using Custodiol-HTK cardioplegia.
  
  
  CONCLUSIONS
  Use of Custodiol-HTK cardioplegia is safe and cost-effective when compared with traditional repetitive blood cardioplegia in patients undergoing minimally invasive and open valve surgery.
authors.affiliation: From the Lee Memorial Health System, Fort Myers, FL USA.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Hummel
authors.forename: Randall W
authors.initials: RW
authors.lastname: Buss
authors.forename: Paul L
authors.initials: PL
authors.lastname: DiGiorgi
authors.forename: Brittany N
authors.initials: BN
authors.lastname: Laviano
authors.forename: Nalani A
authors.initials: NA
authors.lastname: Yaeger
authors.forename: M Lee
authors.initials: ML
authors.lastname: Lucas
authors.forename: George M
authors.initials: GM
authors.lastname: Comas
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000191:economics*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002314:Cardioplegic Solutions / Q000008:administration & dosage / Q000191:economics*; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000191:economics; D006324:Heart Arrest, Induced / Q000191:economics / Q000379:methods; D006801:Humans; D008297:Male; D008353:Mannitol / Q000008:administration & dosage / Q000191:economics; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D011189:Potassium Chloride / Q000008:administration & dosage / Q000191:economics; D011343:Procaine / Q000008:administration & dosage / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose