Despite the heterogeneity, the results from this meta-analysis show a good overall performance of the euroSCORE II in terms of discrimination and accuracy of model predictions for operative mortality. Validation of the euroSCORE II in prospective populations needs to be further studied for a continuous improvement of patients' risk stratification before cardiac surgery.

The ideal cardioplegic strategy in thoracic aorta operations requiring long cardiopulmonary bypass and cross-clamp time has not been established. Suboptimal myocardial protection may lead to myocardial damage and possible post-operative complications. We evaluate post-operative cardiac Troponin I (cTnI) release, low cardiac output syndrome (LCOS) and mortality, using a cold crystalloid single-dose intracellular or cold blood multidose cardioplegia in 112 elective or emergent thoracic aorta operation patients. Fifty-four patients (HTK group) received Custodiol® cardioplegic solution and 58 received cold blood cardioplegia (CB group). Cross-clamp time, cardiopulmonary bypass (CPB) time and cTnI peak release were similar in both groups. No differences were found for atrial and ventricular arrhythmias, inotropic support, LCOS and in-hospital mortality. Two-way ANOVA analysis revealed an interactive effect on cTnI peak (p=0.012) of cardioplegic solution type across the cross-clamp time quintile. In the fifth quintile, cross-clamp time patient (>160 min) cTnI peak value was higher in CB patients (p=0.044). HTK and CB cardioplegic solutions assure similar myocardial protection in patients undergoing thoracic aorta operations. In long cross-clamp times, the lower post-operative cTnI release detected using HTK may be indicative of a better myocardial protection in these extreme conditions.

Custodiol and cold blood cardioplegic solutions seem to assure similar myocardial protection in patients undergoing cardiac surgery through a right mini-thoracotomy approach.

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Background: Minimally invasive cardiac surgery has increasingly been used for patients with valvular pathology. Two techniques of aortic occlusion are utilized with this technique: transthoracic aortic clamp (TTC) and endoaortic balloon occlusion (EAO). Both possibilities present peculiar advantages and limitations whose current evidence is based on few observational studies. We performed an analysis with the primary objective to evaluate outcomes and the incidence of major complications of these two techniques. Methods: The data of 258 patients who underwent minimally invasive mitral valve surgery through right mini-thoracotomy from January 2013 to July 2018 were reviewed. One hundred sixty-five patients were operated on with TTC and in 93 cases EAO was used. Univariate and multivariate analyses were performed to identify predictors of adverse outcome. Results: The mean age of the cohort was 60.4±13.9 years, patients with TTC were significantly older and had higher EuroSCORE II and reoperations were carried out mostly with EAO. Isolated mitral valve surgery was mostly performed (74%) and in 26% of the cases, other procedures were combined. No differences were detected in terms of types of operation, cardiopulmonary bypass (CPB) and cross-clamp times between the two techniques. Similar postoperative troponin I and CK-Mb values were recorded. Twenty-four patients (11%) suffered at least one complication. Of note, a new neurologic deficit occurred in six patients; in four cases a cerebral stroke, with all patients in the EAO group (P=0.06). There was no case of aortic dissection, no patient suffered peripheral ischemia nor femoral vessels complications. Thirty-day mortality was 1.9% (TTC 1.2% vs. EAO 3.2%; P=0.51), 30-day mortality excluding reoperations was 1.2% (TTC 1.2% vs. EAO 1.1%; P=0.61). Conclusions: Both techniques proved to be safe. Although non-statistically significant, there was a higher rate of cerebral stroke in the EAO group. However, EAO system shows technical advantages in avoiding tissue dissection and remains our choice in redo operations.