Myocardial protection during minimally invasive cardiac surgery through right mini-thoracotomy

Palo, Micaela De; Guida, Pietro; Mastro, Florinda; Quagliara, Teresa A P; Rociola, Ruggiero; Lionetti, Giosuè; Paparella, Domenico

doi:10.1177/0267659116679249

Cited by 17 publications

(21 citation statements)

References 38 publications

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“…In the external transthoracic clamp cases, intermittent cold blood cardioplegia has been preferred to avoid further hemodilution. We have previously demonstrated that both crystalloid and cold blood cardioplegia solutions provide adequate protection in minimally invasive cardiac surgery (10).…”

Section: Discussionmentioning

confidence: 99%

External aortic cross-clamping and endoaortic balloon occlusion in minimally invasive mitral valve surgery

Margari¹,

Mastro²,

Visicchio³

et al. 2018

Ann. Cardiothorac. Surg.

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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.

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Section: Discussionmentioning

confidence: 99%

External aortic cross-clamping and endoaortic balloon occlusion in minimally invasive mitral valve surgery

Margari¹,

Mastro²,

Visicchio³

et al. 2018

Ann. Cardiothorac. Surg.

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“…15,36,38 Controversy concerning its use in adults does exist since the solution was initially designed for pediatric use. 39,40 Nevertheless, DN has been shown to be non-inferior to traditional CP formulations that are blood based 41,42 and is employed frequently throughout our hospital base.…”

Section: Discussionmentioning

confidence: 99%

Does the type of cardioplegia used during valve surgery influence operative nadir hematocrit and transfusion requirements?

et al. 2018

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“…Generally, authors who have investigated outcomes following minimally invasive cardiac surgery using Custodiol-HTK solution agreed that avoiding repetitive infusions may reduce the risk for coronary malperfusion due to dislodgement of the endo-aortic clamp (if used) and increase the surgeon's comfort during the procedure. [10][11][12][13][14] Almost all the investigators who have compared Custodiol-HTK with cold blood cardioplegia have shown similar clinical outcomes for the two options. 6,9,[10][11][12]14 Actually, only a few studies have shown some benefits deriving from either one of the two cardioplegic strategies.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13][14] Almost all the investigators who have compared Custodiol-HTK with cold blood cardioplegia have shown similar clinical outcomes for the two options. 6,9,[10][11][12]14 Actually, only a few studies have shown some benefits deriving from either one of the two cardioplegic strategies. For example, lower values (p = 0.044) of cardiac troponin I for XCT >160 minutes have been reported for Custodiol-HTK patients undergoing aortic surgery by Scrascia et al 5 Prathanee et al 15 have stigmatized that by using Custodiol-HTK cardioplegia in isolated CABG there was a significantly increased risk of spontaneous ventricular fibrillation after releasing of the aortic clamp; however, no clinical significance has been given to this fact.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14] However, despite its widespread use in Europe, no conclusive data derives from studies comparing Custodiol-HTK solution with conventional, blood or crystalloid cardioplegia. 5,6,[11][12][13][14][15][16] Actually, there are concerns about hyponatremia that follows the rapid administration of the required high volume of this low-sodium cardioplegic solution 17 as well as the adequacy of myocardial protection offered by only a single dose of cardioplegia. 9,10,16 In effect, the safe cross-clamp time (XCT) of the aorta (or endoaortic clamping time for minimally invasive surgery) using Custodiol-HTK cardioplegia has not been yet established.…”

Section: Introductionmentioning

confidence: 99%

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Safe cross-clamp time using Custodiol^®–histidine-tryptophan-ketoglutarate cardioplegia in the adult

et al. 2019

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Introduction: Safe cross-clamp time using single-dose Custodiol®–histidine-tryptophan-ketoglutarate cardioplegia has not been established conclusively. Methods: Immediate post-operative outcomes of 1,420 non-consecutive, cardiac surgery patients were reviewed retrospectively. Predictors of a combined endpoint made of in-hospital mortality and any major complication post-surgery were found with the multivariable method. Analysis of variance was used to evaluate the impact of cross-clamp time on most relevant complications. Discriminatory power and cut-off value of cross-clamp time were established for in-hospital mortality and each of the major complications (receiver operating characteristic curve analysis). A comparative analysis (with propensity matching) with multidose cold blood cardioplegia on in-hospital mortality post-surgery was performed in non-coronary surgery patients. Results: Coronary, aortic valve and mitral valve surgery and surgery on thoracic aorta were performed in 45.4%, 41.9%, 49.5%, 20.6% of cases, respectively. In-hospital mortality and the rate of any major complication post-surgery were 6.5% and 41.9%, respectively. Cross-clamp time had significant impact on in-hospital mortality and almost all major post-operative complications, except neurological dysfunctions (p = 0.084), myocardial infarction (p = 0.12) and mesenteric ischaemia (p = 0.85). Areas under the receiver operating characteristic curve and the optimal cut-off values for in-hospital mortality and any major complication were of 0.657, 0.594, >140 and >127 minutes, respectively. Comorbidities-adjusted odds ratio for any major complication of cross-clamp time <127 minutes was 1.86 (p < 0.0001). Despite similar in-hospital mortality (p = 0.57), there was an earlier significant increase of mortality in Custodiol–HTK than in multidose cold blood propensity-matched, non-coronary surgery patients. Conclusions: The use of Custodiol–HTK cardioplegia is associated with a low risk of serious post-operative complications provided that cross-clamp time is of 2 hours or less.

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Myocardial protection during minimally invasive cardiac surgery through right mini-thoracotomy

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

Cited by 17 publications

References 38 publications

External aortic cross-clamping and endoaortic balloon occlusion in minimally invasive mitral valve surgery

External aortic cross-clamping and endoaortic balloon occlusion in minimally invasive mitral valve surgery

Does the type of cardioplegia used during valve surgery influence operative nadir hematocrit and transfusion requirements?

Safe cross-clamp time using Custodiol^®–histidine-tryptophan-ketoglutarate cardioplegia in the adult

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Myocardial protection during minimally invasive cardiac surgery through right mini-thoracotomy

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

Cited by 17 publications

References 38 publications

External aortic cross-clamping and endoaortic balloon occlusion in minimally invasive mitral valve surgery

External aortic cross-clamping and endoaortic balloon occlusion in minimally invasive mitral valve surgery

Does the type of cardioplegia used during valve surgery influence operative nadir hematocrit and transfusion requirements?

Safe cross-clamp time using Custodiol®–histidine-tryptophan-ketoglutarate cardioplegia in the adult

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Safe cross-clamp time using Custodiol^®–histidine-tryptophan-ketoglutarate cardioplegia in the adult