Comparison of modified Del Nido and Custodiol® cardioplegia in minimally invasive mitral valve surgery

Author:

Kang Jagdip1ORCID,Hoyer Alexandro1,Dieterlen Maja-Theresa1,Oetzel Hanna1,Otto Wolfgang1,Ginther André1,Pfannmüller Bettina1,Misfeld Martin12345ORCID,Noack Thilo1,Kiefer Philipp1,Borger Michael A1ORCID

Affiliation:

1. University Department of Cardiac Surgery, Leipzig Heart Center , Leipzig, Germany

2. Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital , Sydney, NSW, Australia

3. Sydney Medical School, University of Sydney , Sydney, NSW, Australia

4. Institute of Academic Surgery, Royal Prince Alfred Hospital , Sydney, NSW, Australia

5. The Baird Institute of Applied Heart and Lung Surgical Research , Sydney, NSW, Australia

Abstract

Abstract OBJECTIVES In this study, we evaluated if modified Del Nido cardioplegia delivers comparable cardiac protection in comparison to Custodiol® in patients undergoing isolated minimally invasive mitral valve repair. METHODS From January 2018 to October 2021, all patients undergoing non-emergent isolated minimally invasive mitral valve repair were included in this study. The cardioplegia was chosen at the surgeons’ discretion. The primary end points of this study were peak postoperative cardiac enzyme levels. Secondary end points were in-hospital mortality, hospital stay, occurrence of cardiac arrhythmias, pacemaker implantations, postoperative lactate and sodium levels and postoperative incidence of renal failure requiring dialysis. RESULTS A total of 355 patients were included in this study. The mean age of patients was 57. After propensity score matching, a total of 156 pairs were identified. There was no difference in cross-clamp time between both groups. Postoperative creatine kinase levels were higher in patients receiving Custodiol on the 1st and 2nd postoperative days. Creatine kinase isoenzyme MB levels were higher in patients receiving Custodiol on the 2nd postoperative day (0.5 ± 0.2 vs 0.4 ± 0.1 µmol/l s; P < 0.001). Postoperative Troponin T concentrations were similar between both groups. Maximum lactate concentrations were higher in patients receiving Custodiol on the day of surgery (2.4 ± 1.9 vs 2.0 ± 1.1 mmol/l; P = 0.04). The overall hospital stay was longer in patients receiving Del Nido cardioplegia (10.6 ± 3.2 vs 8 ± 4.1 days; P < 0.01). CONCLUSIONS Modified Del Nido cardioplegia based on Ionosteril® solution offers equivalent protection compared to Custodiol for isolated minimally invasive mitral valve repair.

Publisher

Oxford University Press (OUP)

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