In search of optimal cardioplegia for minimally invasive valve surgery

Abstract

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.

Network meta-analysis comparing blood cardioplegia, Del Nido cardioplegia and custodiol cardioplegia in minimally invasive cardiac surgery

“…None reported a significant difference between the three cardioplegia solutions, suggesting better myocardial protection. 13,18,19 This is similar to the systematic review performed by Russell et al 22 Another advantage includes a reduction of cardioplegic volume required, which results in less haemodilution and subsequently decreases the need for postoperative red blood cell transfusion. 7,23,24 This is also seen in our findings, in which the cardioplegic volume is significantly lower in the DNC group.…”