Myocardial protection during minimally invasive cardiac surgery through right mini-thoracotomy.
BACKGROUND
Myocardial damage is an independent predictor of adverse outcome following cardiac surgery and myocardial protection is one of the key factors to achieve successful outcomes. Cardioplegia with Custodiol is currently the most used cardioplegia during minimally invasive cardiac surgery (MICS). Different randomized controlled trials compared blood and Custodiol cardioplegia in the context of traditional cardiac surgery. No data are available for MICS.


OBJECTIVE
The aim of this study was to compare the efficacy of cold blood versus Custodiol cardioplegia during MICS.


METHODS
We retrospectively evaluated 90 patients undergoing MICS through a right mini-thoracotomy in a three-year period. Myocardial protection was performed using cold blood (44 patients, CBC group) or Custodiol (46 patients, Custodiol group) cardioplegia, based on surgeon preference and complexity of surgery.


RESULTS
The primary outcomes were post-operative cardiac troponin I (cTnI) and creatine kinase MB (CKMB) serum release and the incidence of Low Cardiac Output Syndrome (LCOS). Aortic cross-clamp and cardiopulmonary bypass times were higher in the Custodiol group. No difference was observed in myocardial injury enzyme release (peak cTnI value was 18±46 ng/ml in CBC and 21±37 ng/ml in Custodiol; p=0.245). No differences were observed for mortality, LCOS, atrial or ventricular arrhythmias onset, transfusions, mechanical ventilation time duration, intensive care unit and total hospital stay.


CONCLUSIONS
Custodiol and cold blood cardioplegic solutions seem to assure similar myocardial protection in patients undergoing cardiac surgery through a right mini-thoracotomy approach.
Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.
Micaela
M
De Palo
Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.
Pietro
P
Guida
Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.
Florinda
F
Mastro
Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.
Daniela
D
Nanna
Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.
Teresa A P
TA
Quagliara
Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.
Ruggiero
R
Rociola
Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.
Giosuè
G
Lionetti
Department of Emergency and Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy.
Domenico
D
Paparella
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D001803:Blood Transfusion / Q000379:methods; D002303:Cardiac Output, Low / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006321:Heart / Q000187:drug effects / Q000502:physiology / Q000503:physiopathology*; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011189:Potassium Chloride / Q000627:therapeutic use; D011343:Procaine / Q000627:therapeutic use; D012189:Retrospective Studies; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D019210:Troponin I / Q000097:blood
C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D019210:Troponin I; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D052279:Creatine Kinase, MB Form; D005947:Glucose
cardioplegia; mini-thoracotomy; minimally invasive cardiac surgery; myocardial protection; outcomes