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

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):  
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.

scholarly journals Minimally Invasive Mitral Valve Surgery I: Patient Selection, Evaluation, and Planning

2016 ◽  
Vol 11 (4) ◽  
pp. 243-250 ◽  
Author(s):  
Gorav Ailawadi ◽  
Arvind K. Agnihotri ◽  
John R. Mehall ◽  
J. Alan Wolfe ◽  
Brian W. Hummel ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Best Practices ◽  
Minimally Invasive ◽  
Myocardial Protection ◽  
Preoperative Planning ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Patient Evaluation ◽  
Valve Repair ◽  
Selection For

Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection.

scholarly journals In search of optimal cardioplegia for minimally invasive valve surgery

Perfusion ◽  
2021 ◽  
pp. 026765912110125
Author(s):  
Sion Russell ◽  
Salman Butt ◽  
Hunaid A Vohra
Keyword(s):  
Cardiac Arrest ◽  
Minimally Invasive ◽  
Myocardial Protection ◽  
Myocardial Damage ◽  
Valve Surgery ◽  
Cardioplegic Solution ◽  
Comprehensive Literature Review ◽  
Pros And Cons ◽  
Minimally Invasive Valve Surgery ◽  
Cardioplegic Solutions

Cardioplegic solutions are used in cardiac surgery to achieve controlled cardiac arrest during operations, making surgery safer. Cardioplegia can either be blood or crystalloid based, with perceived pros and cons of each type. Whilst it is known that cardioplegia causes cardiac arrest, there is debate over which cardioplegic solution provides the highest degree of myocardial protection during arrest. Myocardial damage is measured post-operatively by biomarkers such as serum TnT, TnI or CK-MB. It is known that the outcomes of minimally invasive valve surgery are comparable to full sternotomy valve operations. Despite there being a wide diversity in use of different cardioplegic solutions across the world, this comprehensive literature review found no superiority of one cardioplegic solution over the other for myocardial protection during minimally invasive valve procedures.

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