Minimally invasive cardiopulmonary bypass with cardioplegic arrest: A closed chest technique with equivalent myocardial protection

AbstractBackgroundRemote ischaemic pre-conditioning and cardiac ischaemic post-conditioning provide myocardial protection in cardiac surgery. However, these two endogenous strategies have not been directly compared in a clinical setting. The purpose of this study was to compare the efficacy of remote ischaemic pre-conditioning and post-conditioning in providing myocardial protection to children undergoing cardiopulmonary bypass for surgical repair of ventricular septal defect.MethodsWe randomly assigned 60 paediatric patients scheduled for surgical correction of congenital ventricular septal defect to the post-conditioning group (n = 20), remote pre-conditioning group (n = 20), or control group (n = 20). Post-conditioning consisted of 30 seconds of ischaemia and 30 seconds of reperfusion achieved by clamping and unclamping the aorta, repeated three times over 3 minutes immediately after cardioplegic arrest. Remote ischaemic pre-conditioning consisted of 5 minutes of lower limb ischaemia followed by 5 minutes of reperfusion using a blood-pressure cuff inflated to a pressure of 200 millimetres of mercury, also repeated three times over 30 minutes. We assayed creatine kinase-MB, troponin I.ResultsMean age, cardiopulmonary bypass times, and aortic cross-clamp times were matched across groups. Both post-conditioning and remote ischaemic pre-conditioning reduced the peak release of creatine kinase-MB (86.1 plus or minus 24.1 units per litre and 92.8 plus or minus 20.6 units per litre, respectively, versus 111.0 plus or minus 44.6 units per litre in the control, p less than 0.05) and troponin I (0.28 plus or minus 0.10 nanogram per millilitre and 0.26 plus or minus 0.09 nanogram per millilitre, respectively, versus 0.49 plus or minus 0.19 nanogram per millilitre in the control group, p less than 0.05).ConclusionsOur study demonstrates that ischaemic post-conditioning and remote ischaemic pre-conditioning provide comparable myocardial benefit in children undergoing cold blood cardioplegic arrest.

Download Full-text

Minimally invasive mitral valve surgery through right mini-thoracotomy: recommendations for good exposure, stable cardiopulmonary bypass, and secure myocardial protection

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-015-0541-z ◽

2015 ◽

Vol 63 (7) ◽

pp. 371-378 ◽

Cited By ~ 13

Author(s):

Toshiaki Ito

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Minimally Invasive ◽

Myocardial Protection ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Good Exposure ◽

Mini Thoracotomy

Download Full-text

Clinical Experience with Minimally Invasive Coronary Artery and Mitral Valve Surgery with the Advantage of Cardiopulmonary Bypass and Cardioplegic Arrest Using the Port Access Technique

World Journal of Surgery ◽

10.1007/pl00012335 ◽

1999 ◽

Vol 23 (5) ◽

pp. 480-485 ◽

Cited By ~ 4

Author(s):

Vassilios Gulielmos ◽

Florian M. Wagner ◽

Beate Waetzig ◽

Natalja Solowjowa ◽

Sems M. Tugtekin ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Artery ◽

Mitral Valve ◽

Minimally Invasive ◽

Clinical Experience ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Cardioplegic Arrest ◽

Port Access ◽

Access Technique

Download Full-text

Myocardial Protection in Minimally Invasive Mitral Valve Surgery

Case Medical Research ◽

10.31525/ct1-nct04231903 ◽

2020 ◽

Author(s):

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Myocardial Protection ◽

Mitral Valve Surgery ◽

Valve Surgery

Download Full-text

Impact of cardiopulmonary bypass and cardioplegic arrest on myocardial lymphatic function

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1995.268.1.h178 ◽

1995 ◽

Vol 268 (1) ◽

pp. H178-H183 ◽

Cited By ~ 9

Author(s):

U. Mehlhorn ◽

K. L. Davis ◽

E. J. Burke ◽

D. Adams ◽

G. A. Laine ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Left Ventricular Function ◽

Ventricular Function ◽

Myocardial Edema ◽

Dry Weight ◽

Myocardial Contraction ◽

Left Ventricular ◽

Lymph Flow ◽

Cardioplegic Arrest ◽

Lymphatic Function

Cardioplegic arrest (CPA) is associated with interstitial myocardial edema, which has been shown to impair myocardial function. The accumulation of interstitial myocardial edema may be enhanced by impaired myocardial lymph flow. The purpose of this study was to investigate the effects of CPA on myocardial lymphatic function. In nine anesthetized dogs, we cannulated a prenodal cardiac lymphatic and measured myocardial lymph flow rate (QL), myocardial lymph driving pressure (PL), and myocardial lymph hyaluronan (Hya) concentration. We determined left ventricular function using pressure-volume curves derived by sonomicrometry and micromanometry. The dogs were placed on cardiopulmonary bypass (CPB) (28 degrees C) and subjected to 60 min of hypothermic, crystalloid CPA. With the onset of asystole both QL and PL decreased significantly from 70.7 +/- 31.8 (SD) to 3.3 +/- 4.0 microliters/min and from 19.9 +/- 8.0 to 10.4 +/- 1.8 mmHg, respectively (P < 0.01). Following return of sinus rhythm after separation from CPB, QL and PL increased significantly to 135.4 +/- 28.0 microliters/min and 27.3 +/- 7.5 mmHg, respectively (P < 0.01). Post-CPA myocardial edema was demonstrated by gravimetric wet-to-dry weight determination of 3.67 +/- 0.20 (normal 2.90 +/- 0.20, P < 0.001) and was associated with significantly decreased left ventricular function. Myocardial Hya turnover rate was 1.3 +/- 1.0% per day under baseline conditions and increased significantly to 2.7 +/- 0.9% per day post-CPA (P < 0.01). We conclude that organized myocardial contraction is the major determinant of myocardial lymph flow. Myocardial lymph flow impairment during CPA may contribute to post-CPA myocardial edema and left ventricular dysfunction.

Download Full-text

Myocardial Protection in Mitral Valve Surgery: Comparison Between Minimally Invasive Approach and Standard Sternotomy

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2017.08.040 ◽

2018 ◽

Vol 32 (2) ◽

pp. 656-663 ◽

Cited By ~ 4

Author(s):

Jean-Sébastien Lebon ◽

Pierre Couture ◽

Annik Fortier ◽

Antoine G. Rochon ◽

Christian Ayoub ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Myocardial Protection ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Minimally Invasive Approach ◽

Invasive Approach

Download Full-text

Myocardial Protection and Financial Considerations of Custodiol Cardioplegia in Minimally Invasive and Open Valve Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000314 ◽

2016 ◽

Vol 11 (6) ◽

pp. 420-424 ◽

Cited By ~ 11

Author(s):

Brian W. Hummel ◽

Randall W. Buss ◽

Paul L. DiGiorgi ◽

Brittany N. Laviano ◽

Nalani A. Yaeger ◽

...

Keyword(s):

Single Dose ◽

Minimally Invasive ◽

Myocardial Protection ◽

Gulf Coast ◽

Medical Center ◽

Valve Surgery ◽

Hospital Charges ◽

Retrospective Case ◽

Equal Distribution ◽

Blood Cardioplegia

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.

Download Full-text