del Nido and Histidine-Tryptophan-Ketoglutarate cardioplegia in minimally invasive mitral valve surgery: A propensity-Match study

Abstract

Introduction In the last decade, del Nido cardioplegia has been embedded in adult cardiac surgery involving CABG and aortic valve surgical procedures. We reviewed our early experience with del Nido cardioplegia in the setting of minimally invasive mitral valve surgery. Methods Data on 120 consecutive patients operated between 03/2021 and 06/2022 were retrieved from our internal database (infective endocarditis and urgent operations were excluded). Patients were divided into two groups according to the use of Histidine-Tryptophan-Ketoglutarate or del Nido cardioplegia. A propensity match analysis was performed using thirteen preoperative and intraoperative variables. Several intraoperative data and early postoperative outcomes were investigated, including cardiac enzymes (Troponin I HS and CK-MB) measured upon arrival in the Intensive Care Unit (ICU), after 12 hours and everyday thereafter. Results There was no difference in preoperative characteristics and surgical techniques between both unmatched and matched Histidine-Tryptophan-Ketoglutarate and del Nido populations. Patients in the del Nido group received a lower volume of cardioplegia ( p < 0.001) and ultrafiltration during CPB ( p < 0.001). Histidine-Tryptophan-Ketoglutarate was associated with a lower rate of post cross-clamp spontaneous defibrillation ( p < 0.001) and showed a lower level of blood sodium after CPB ( p < 0.001). The release of cardiac enzymes was similar between the two groups ( p = 0.72). There was no difference in terms of postoperative morbidity and 30 day mortality. Conclusions del Nido cardioplegia in the setting of minimally invasive mitral valve surgery seemed safe with acceptable myocardial protection and excellent early outcomes.

Minimally Invasive Trans-Axillary versus Full Sternotomy Mitral Valve Repair: A Propensity Score-Matched Analysis on Mid-Term Outcomes

“…The aorta was occluded using a flexible clamp introduced through the mini-thoracotomy access; the heart was arrested with antegrade cardioplegia. Histidine-Tryptophan-Ketoglutarate cardioplegia was used until December 2021, Del Nido cardioplegia was given in all the cases thereafter [13]. The left atrium was opened using a left atrial atriotomy in the inter-atrial groove.…”