One-shot cardioplegia for minimally invasive mitral valve repair-a comparison of del Nido and Bretschneider Histidine-Tryptophan-Ketoglutarate solutions

Gerber, Witold; Sanetra, Krzysztof; Gerber, Agnieszka Drzewiecka-; Jankowska-Sanetra, Justyna; Kuczera, M; Białek, Krzysztof; Buszman, Piotr P.; Bochenek, Andrzej

doi:10.1177/02676591221080653

Cited by 3 publications

(3 citation statements)

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“…23 There is limited literature focusing on outcomes of patients who underwent minimally invasive mitral surgery using del Nido cardioplegia. These studies provided a direct comparison between patients who had del Nido cardioplegia versus HTK or St Thomas solutions [12][13][14] and showed, by including operations with a median crossclamp time range of [54-76] minutes, equivalent results in terms of early mortality and morbidity and lower release of myocardial enzymes after del Nido cardioplegia. 12 Our data showed that there was no difference in postoperative peak Troponin I HS and CK-MB between the two groups both in the overall matched populations and in patients who underwent isolated mitral surgery.…”

Section: Commentmentioning

confidence: 99%

“…[9][10][11] Few data are available regarding its use in minimally invasive mitral valve surgery and a limited number of studies have compared del Nido and HTK solutions. [12][13][14] The aim of our study was to review and compare the early clinical outcomes associated with the use of del Nido and HTK cardioplegia solutions in the setting of right mini-thoracotomy mitral valve surgery.…”

Section: Introductionmentioning

confidence: 99%

“…9–11 Few data are available regarding its use in minimally invasive mitral valve surgery and a limited number of studies have compared del Nido and HTK solutions. 12–14…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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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.

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Section: Commentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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

Kang,

Hoyer,

Dieterlen

et al. 2024

European Journal of Cardio-Thoracic Surgery

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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.

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Optimizing Myocardial Protection in Minimally Invasive Cardiac Surgeries: A Network Comparison of Del Nido, Histidine-Tryptophan-Ketoglutarate, and Blood Cardioplegia

Al-Hasan-Al-Saegh,

Takemoto,

Benenati

et al. 2024

JCM

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Background/Objectives: The optimal choice of cardioplegia solution in minimally invasive cardiac surgeries (MICS) remains debated, as prolonged myocardial protection is essential to avoid interruptions to the surgical flow, which can prolong aortic cross-clamp time and cardiopulmonary bypass time, especially in the constrained surgical field. We conducted a network meta-analysis to evaluate the safety and efficacy of the del Nido (DN), histidine-tryptophan-ketoglutarate (HTK), blood cardioplegia (BC), and St. Thomas’ (STH) solutions in MICS. Methods: Medical electronic databases were thoroughly searched without time restrictions, including all types of studies except for study protocols and animal research. The final search was completed in June 2024. Subsequently, a network meta-regression was performed on both primary and secondary endpoints, utilizing R (The R Foundation for Statistical Computing, version 3.6.2) for the analysis. Meta-analyses were carried out using Review Manager software. Results: A total of 15 studies, enrolling 2282 patients, were included in the analysis. None of the comparisons showed statistically significant differences in in-hospital mortality between the four cardioplegia solutions (BC vs. HTK, OR: 3.21, 95% CI: 0.13–80.84; DN vs. HTK, OR: 1.42, 95% CI: 0.28–7.23; STH vs. HTK, OR: 1.25, 95% CI: 0.19–8.20). Conclusions: In this network meta-analysis of cardioplegia solutions in MICS, no significant differences were observed in major clinical outcomes across the solutions. Cardioplegia solutions that provide long-lasting myocardial protection with a single dose, such as DN and HTK, were found to be safely applied in MICS. DN was associated with shorter CPB times and HTK was associated with shorter hospital stays, though these differences may not have clinical implications.

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One-shot cardioplegia for minimally invasive mitral valve repair-a comparison of del Nido and Bretschneider Histidine-Tryptophan-Ketoglutarate solutions

Cited by 3 publications

References 22 publications

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

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

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

Optimizing Myocardial Protection in Minimally Invasive Cardiac Surgeries: A Network Comparison of Del Nido, Histidine-Tryptophan-Ketoglutarate, and Blood Cardioplegia

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