Terminal Warm Blood Cardioplegia in Mitral Valve Replacement: Prospective Study

Abstract

Terminal warm blood cardioplegia has had a profound impact on cardiac surgery, especially in coronary artery bypass surgery, but there have been few studies on its use in mitral valve replacement. The purpose of this study was to determine whether terminal warm blood cardioplegia offers any advantages in mitral valve replacement. Forty patients with mitral valve disease were prospectively randomized to one of two groups of 20 with different techniques of myocardial protection: group A had cold blood cardioplegia, and group B had cold blood cardioplegia with terminal warm blood cardioplegia. Intraoperative and postoperative variables were used to assess primary outcomes. Postoperative troponin T release was measured as a secondary outcome. Improved spontaneous recovery of sinus rhythm was observed in group B, but the difference was not significant. The maximum doses of inotropics, duration of inotropic support, intensive care unit stay, and postoperative left ventricular ejection fraction were similar in both groups. Troponin T release at 0 and 6 h postoperatively was not different between the two groups. This study did not find any benefit of terminal warm blood cardioplegia in either clinical outcome or troponin T release after mitral valve replacement.

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

“…It evaluates the associations between these methods and the immediate postoperative and shortterm outcomes. The current research in this field is limited to individual institutions, [28][29][30][31][32][33][34] whereas our study summarizes techniques and outcomes from a national registry, the Society of Thoracic Surgeons (STS) database. It comprises close to 5000 patients who underwent MIMVS in the USA during the study period.…”

“…As in the whole cohort, in multivariate analysis, antegrade-crystalloid (OR, 2.112; 95%CI, 1.548-2.882; P< .001), and antegrade/retrograde-blood/crystalloid (OR, 1.786; 95%CI, 1.009-3.160; P = .046) cardioplegia were associated with an increased risk of an ICU stay of 70 hours or more compared with antegrade-blood cardioplegia. DISCUSSION MIMVS has become a common method of mitral valve repair or replacement(28)(29)(30)(31)(32). Several techniques and methods of myocardial preservation have been described in patients undergoing mitral valve surgery using this approach.…”