Myocardial preservation methods in isolated minimal invasive mitral valve surgery: Society of Thoracic Surgeons (STS) database outcomes

Abstract

Objective: Minimal invasive mitral valve surgery (MIMVS) has become a commonly used approach for mitral valve surgery. Several techniques of myocardial preservation were described in patients undergoing MIMVS. We aim to evaluate preservation technique and short term outcomes.Methods: A retrospective analysis of patients who underwent isolated MIMVS and were included in the Society of Thoracic Surgeons (STS) database. Results:The final cohort included 4976 patients. Mean age was 63.1 years (SD, 12.5) and 42.6% were females. Antegrade delivery method (71.3% of the patients) was the most common, follow by antergrade/retrograde (19.9%). Blood, crystalloid solution, and combination of blood-crystalloid were used in 62.4%, 13.2%, and 13.7%, respectively. In multivariate analysis, cardioplegia technique was associated with mortality (P = .011), pleural effusion (P = .045), and length of ICU stay (P < .001).Antegrade-crystalloid (OR, 3.37; 95%CI, 1.70-6.68) and antegrade/retrograde-blood/ crystalloid (OR, 3.28; 95%CI, 1.15-9.38) were associated with increased risk for mortality compared with antegrade-blood cardioplegia. Data on postoperative ejection fraction (EF), CPK-MB, and Troponin was available only in 30%, 9%, and 5% of the patients, respectively, and were not included in the analysis.Conclusions: Ante-grade-blood was the most common preservation technique in MIMVS. Ante-grade-crystalloid and ante-grade/retrograde-blood/crystalloid are associated with increased risk for mortality. The results suggest that using crystalloid solutions for cardioplegia should be carefully considered. The STS database as a source for MIMVS outcome analysis is lacking, both in detailed specification of different surgical technique aspects, and in actual data collection of already existing categories.

At the Crossroads of Minimally Invasive Mitral Valve Surgery—Benching Single Hospital Experience to a National Registry: A Plea for Risk Management Technology

“…There are also recommendations for caution [ 28 ]. In MIMVS, the devil is in the details, and special care is called for in the administration of cardioplegia [ 29 ], and optimal venous drainage [ 30 ]. Additionally, in a comparative study between open-sternum and robotic-assisted mitral valve surgery, the myocardium was found to remain warmer for a longer time in robotic surgery [ 31 ].…”

Single-Dose St. Thomas Versus Custodiol® Cardioplegia for Right Mini-thoracotomy Mitral Valve Surgery

“…Several studies comparing different types of cardioplegia have been reported with controversial results [23][24][25]. A recent multivariate analysis from the Society of Thoracic Surgeons (STS) database on 4976 isolated minimally invasive MV procedures showed that crystalloid and blood/ crystalloid cardioplegia were associated with significant increased risk of mortality and of longer ICU stay compared with blood cardioplegia [1]. However, myocardial biomarkers and postoperative cardiac function are lacking in the STS database, and the specific type of solution administered for cardiac protection is not precisely reported.…”

“…Adequate and safe myocardial protection is essential to achieve optimal results in cardiac surgery, regardless of the type of surgical procedure and the approach. Suboptimal myocardial protection during cardiopulmonary bypass is an independent predictor of perioperative adverse events, including myocardial infarction, ischemia–reperfusion injury, arrhythmias, and low cardiac output syndrome, which are associated with prolonged intensive care unit and hospital length of stay, and increased mortality [ 1 ].…”

In search of optimal cardioplegia for minimally invasive valve surgery

“…The notion that the best cardioplegic solution for myocardial protection is yet to be found has been supported in several reviews. 25,26 It can be concluded that current cardioplegic solutions are equally effective at protecting the myocardium during MIVS. For all practical purposes, the use of BC or CC comes down to operator preference.…”

“…The limited use of biomarkers to reveal myocardial damage has been observed in other reviews on the topic. 26 The lack of sources that emerged from the literature search shows that more work must be done to establish whether a specific cardioplegic solution provides better myocardial protection compared to others for MIVS.…”