Comparison of modified Del Nido and Custodiol® cardioplegia in minimally invasive mitral valve surgery

Abstract

OBJECTIVES In this study, we evaluated if modified Del Nido cardioplegia delivers comparable cardiac protection in comparison to Custodiol® in patients undergoing isolated minimally invasive mitral valve repair. METHODS From 01/2018 to 10/2021 all patients undergoing non emergent isolated minimally invasive mitral valve repair were included in this study. The cardioplegia was chosen at the surgeons’ discretion. The primary end-points of this study were peak postoperative cardiac enzyme levels. Secondary end-points were in-hospital mortality, hospital stay, occurrence of cardiac arrhythmias, pacemaker implantations, postoperative lactate and sodium levels and postoperative incidence of renal failure requiring dialysis. RESULTS A total of 355 patients were included in this study. The mean age of patients was 57. After propensity score matching, a total of 156 pairs were identified. There was no difference in cross-clamp time between both groups. Postoperative Creatine kinase levels were higher in patients receiving Custodiol® on the 1st and 2nd postoperative day. CK-MB levels were higher in patients receiving Custodiol® on the 2nd postoperative day (0.5 ± 0.2 µmol/L*s vs 0.4 ± 0.1 µmol/L*s; p < 0.001). Postoperative Troponin T concentrations were similar between both groups. Maximum lactate concentrations were higher in patients receiving Custodiol on the day of surgery (2.4 ± 1.9 mmol/L vs 2.0 ± 1.1 mmol/L; p = 0.04). The overall hospital stay was longer in patients receiving Del Nido cardioplegia (10.6 ± 3.2 days vs 8 ± 4.1 days; p < 0.01). CONCLUSIONS Modified Del Nido cardioplegia based on Ionosteril® solution offers equivalent protection compared to Custodiol® for isolated minimally invasive mitral valve repair.