Celsior^® crystalloid cardioplegia versus standard hyperkalemic normothermic blood cardioplegia: Analysis of myocardial protection in elective mitral valve repair

Abstract

Introduction: With the increase and refinement of video assisted mitral valve surgery, cristalloïd cardioplegia started regaining popularity. The aim of our study was to evaluate the effectiveness of Celsior®, a crystalloid cardioplegic solution, on myocardial protection in elective surgical mitral valve repair in comparison to blood based hyperkalemic cardioplegia. Methods: In this observational retrospective study, all consecutive elective isolated surgical mitral valve repair where Celsior® or normothermic hyperkalemic blood cardioplegia were used were included. Primary endpoint was any sign of myocardial protection failure (troponin levels, need for inotropic or mechanical support, rhythm disturbances, mortality). Secondary endpoint was Celsior® safety (allergic reactions, bleeding, organ toxicities). Results: From January 2009 to August 2016, 382 patients underwent elective isolated mitral valve repair in whom normothermic hyperkalemic blood cardioplegia ( n = 181) or Celsior® ( n = 201) were used. There were no statistically significant differences in baseline characteristics including Euroscore 2. Peak troponin (pg/ml) release and 30-days mortality were not statistically different. Need for cardioversion was significantly more frequent in the Celsior® group (47% vs 13%, p < 0.001). There was no statistical difference in post-operative atrial fibrillation, permanent pacemaker implantation, reoperation for bleeding, transfusion, acute kidney injury, haemoglobin at discharge or length of stay. No allergic reaction to Celsior® occurred. Conclusion: Effective myocardial protection was achieved with the Celsior® cardioplegic solution with no unexpected toxicity. Celsior® may be an efficacious and safe cardioprotective strategy in mitral valve repair.

Celsior® vs. St Thomas® cardioplegia: analysis of myocardial protection and clinical safety in neonates

“…The absolute variation of measured troponin was higher with the US TnI, as it is a more sensitive biomarker ( 14 ), but the same trend was observed in both types of troponins analyzed. The same trends in absolute postoperative increase and progressive decline have been observed in the adult population ( 4 , 15 ). As the introduction of the US TnI assay corresponded roughly to the introduction of Celsior® in our day-to-day practice, we cannot affirm that the new solution had any significant impact on postoperative troponin release and no adverse effect on myocardial protection.…”

“…There are also reports of it being used for myocardial protection during conventional and minimally invasive cardiac surgery. Most of these reports focus on adults ( 3 , 4 , 11 ). There is a lack of knowledge regarding its' clinical effectiveness and safety in children, infants and neonates; published papers have focused on ultrastructural changes following cardioplegia administration ( 12 ) and its effectiveness as an organ preservation solution.…”

“…It has demonstrated its effectiveness in protecting the myocardium of transplanted hearts, where it was used as a preservation solution ( 1 , 2 ). Recent studies have shown that Celsior® can be safely used in simple and complex adult cardiac surgery ( 3 , 4 ).…”