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

2016 ◽  
Vol 11 (6) ◽  
pp. 420-424 ◽  
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.

Safety of Single-Dose Histidine-Tryptophan-Ketoglutarate Cardioplegia during Minimally Invasive Mitral Valve Surgery

2014 ◽  
Vol 9 (6) ◽  
pp. 416-420 ◽  
Author(s):  
Carlo Savini ◽  
Giacomo Murana ◽  
Marco Di Eusanio ◽  
Sofia Martin Suarez ◽  
Giuliano Jafrancesco ◽  
...  
Keyword(s):  
Single Dose ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Myocardial Protection ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Aortic Cross Clamp Time ◽  
Htk Solution ◽  
Cardioplegic Solutions ◽  
Creatine Kinase Isoenzyme Mb

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-tryptophanketoglutarate 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.

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

2018 ◽  
Vol 32 (2) ◽  
pp. 656-663 ◽  
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

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

2016 ◽  
Vol 11 (6) ◽  
pp. 420-424
Author(s):  
Brian W. Hummel ◽  
Randall W. Buss ◽  
Paul L. DiGiorgi ◽  
Brittany N. Laviano ◽  
Nalani A. Yaeger ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Myocardial Protection ◽  
Valve Surgery

Comparative Effects of Single-Dose Cardioplegic Solutions Especially in Repeated Doses During Minimally Invasive Aortic Valve Surgery

2020 ◽  
pp. 155698452096711
Author(s):  
Serdar Gunaydin ◽  
Esin Akbay ◽  
Orhan Eren Gunertem ◽  
Kevin McCusker ◽  
Atike Tekeli Kunt ◽  
...  
Keyword(s):  
Single Dose ◽  
Aortic Valve ◽  
Minimally Invasive ◽  
Myocardial Protection ◽  
Av Block ◽  
Safety Level ◽  
Ischemic Time ◽  
Icu Stay ◽  
Myocardial Biopsies ◽  
Cardioplegic Solutions

Objective This study aims to compare del Nido cardioplegia (DNC) and histidine–tryptophan–ketoglutarate (HTK) cardioplegic solutions in minimally invasive aortic valve replacement (mini-AVR) surgery to discuss the safety level of myocardial protection and rationale for redosing intervals. Methods During the period from January 2017 to June 2019, 200 patients undergoing mini-AVR (solely or with concomitant procedures) were prospectively randomized to DNC ( n = 100) and HTK ( n = 100), both up to 90 minutes ischemic time. Patients with ischemic time over 90 minutes, needing a redosing, were further analyzed in 2 subgroups with DNC-R ( n = 30) and HTK-R ( n = 36). Sensitive biomarkers, in addition to routine biochemistry, were also documented at baseline (T1), after cessation of cardiopulmonary bypass (T2), and on the first postoperative day (T3). Transmural myocardial biopsies were sampled for staining. Results No statistical differences could be demonstrated in DNC and HTK groups with up to 90 minutes cross-clamp times in routine biochemical measurements and basic perioperative clinical outcomes. DNC-R showed significantly more arrhythmia/AV block incidence resulting in more extended intensive care unit (ICU) stay. Interleukin-6 and syndecan-1 in DNC and DNC-R groups were substantially higher at T2. Aquaporin-4 levels were significantly lower in the DNC-R group, demonstrating unsatisfactory response of cells to an excessive volume at T2. Conclusions DNC and HTK provided acceptable myocardial protection as single-dose applications. DNC-R had significantly unbalanced levels of biomarkers, and more arrhythmia/AV block incidence resulting in more extended ICU stay. For patients who may need redosing HTK may be preferable to DNC.

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