Del Nido cardioplegia in the setting of minimally invasive aortic valve surgery

The purpose of this study is to report our experience with del Nido cardioplegia (DNC) in the setting of minimally invasive aortic valve surgery. Forty-six consecutive patients underwent minimally invasive aortic valve replacement (AVR) through a “J” ministernotomy: twenty-five patients received the DNC (Group 1) and 21 patients received standard blood cardioplegia (SBC) (Group 2). The rate of ventricular fibrillation at unclamping was significantly lower in the DNC group (12% vs 52%, p=0.004), as well as postoperative creatinine kinase-MB (CK-MB) values (11.4±5.2 vs 17.7±6.9 µg/L, p=0.004). There were no deaths, myocardial infarctions or major complications in either group. Less postoperative use of intravenous insulin (28% vs 81%, p<0.001) was registered in the DNC group. In conclusion, the DNC is easy to use and safe during minimally invasive AVR, providing a myocardial protection at least equivalent to our SBC, improved surgical efficiency, minimal cost and less blood glucose perturbations.

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Improved myocardial protection in minimally invasive aortic valve surgery with the assistance of port-access technology

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(98)00442-5 ◽

1998 ◽

Vol 116 (5) ◽

pp. 874-875 ◽

Cited By ~ 11

Author(s):

Shubjeet Kaur ◽

Jorge Balaguer ◽

Thomas J. Vander Salm

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Myocardial Protection ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Access Technology ◽

Port Access

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Comparison of warm versus cold blood cardioplegia for myocardial protection in patients with prolonged aortic cross-clamp times during isolated CABG and aortic valve surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269021 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

E Kuhn ◽

OJ Liakopoulos ◽

L Brehmer ◽

I Slottosch ◽

AC Stabbert ◽

...

Keyword(s):

Aortic Valve ◽

Myocardial Protection ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Aortic Cross Clamp ◽

Blood Cardioplegia ◽

Cold Blood ◽

Cold Blood Cardioplegia

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Introduction: minimally invasive aortic valve surgery supplement

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezx481 ◽

2018 ◽

Vol 53 (suppl_2) ◽

pp. ii1-ii2

Author(s):

Michael A Borger

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Valve Surgery ◽

Aortic Valve Surgery

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One incision, two cannulations for minimally invasive aortic valve surgery

International Journal of Cardiology ◽

10.1016/j.ijcard.2014.12.170 ◽

2015 ◽

Vol 182 ◽

pp. 97 ◽

Cited By ~ 1

Author(s):

Shuyang Lu ◽

Lai Wei ◽

Xiaoning Sun ◽

Chunsheng Wang

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Valve Surgery ◽

Aortic Valve Surgery

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Abstract 12048: Minimally Invasive Access for Aortic Valve Surgery in Octogenarians: Is it Still Justified in the Days of TAVI ?

Circulation ◽

10.1161/circ.132.suppl_3.12048 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Udo Boeken ◽

Sudharson Rajah ◽

Jan Philipp Minol ◽

Payam Akhyari ◽

Artur Lichtenberg

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Hospital Stay ◽

Surgical Techniques ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Partial Sternotomy ◽

Number Of Patients ◽

Duration Of Surgery ◽

Minimally Invasive Access

Introduction: Increasing life expectancy in the western world and improvements in surgical techniques and postoperative care have resulted in a significant number of patients aged over 80 undergoing cardiac operations. At times of transapical and transfemoral AVR we aimed to evaluate the feasibility of partial sternotomy for patients over 80 years of age and to compare these results with a historical group of octogenarians who underwent aortic valve surgery via full sternotomy in our department between 1998 and 2006. Methods: 72 of the 275 patients (26.2 %) who underwent aortic valve replacement (AVR) after partial sternotomy between 8/2009 and 05/2013 were octogenarians. Mean age was 83.1 ± 3.9 years (group ps). We compared this group with 165 patients (mean age 81.6 ± 3.1 years) who underwent AVR via full sternotomy between 1998 and 2006 (group fs). Results: ICU- and hospital stay were significantly reduced in patients with partial sternotomy (ps: 28 ± 9 hours, 12.8 ± 4.7 days vs. fs: 59 ± 15 h, 14.7 ± 3.5 d, p<0.05). We found a higher in-hospital mortality in group fs, but without significance (4.2 vs. 2.8 % in ps). Duration of operation, of extracorporeal circulation, and of aortic cross-clamping was tendentially prolonged in patients with partial sternotomy (p>0.05). Necessity for re-operation due to bleeding was comparable in both groups (ps: 2.8 % vs. fs: 3.0 %). The incidence of postoperative complications did not differ significantly between both groups: neurological complications (ps: 2.8 vs. fs: 3.0 %), sternal wound infections (2.8 % vs. 2.4 %) and postoperative LCOS (4.2 % vs. 5.5 %). Conclusions: We could prove the feasibility of ministernotomy for aortic valve surgery for patients over 80 years of age. Despite a tendentially prolonged duration of surgery compared to procedures via full sternotomy, we found a comparable morbidity and a reduced mortality after partial sternotomy. From an economic perspective, the reduction of intensive care unit- and hospital stay after minimally invasive access was the most interesting finding. Moreover, our results after minimally invasive AVR have to be considered carefully when selecting patients for a conventional or for a TAVI procedure.

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