Cristina Barbero1, Marco Pocar2,3,4, Giovanni Marchetto2, Erik Cura Stura2, Claudia Calia2,3, Bianca Dalbesio2, Claudia Filippini3, Stefano Salizzoni2,3, Massimo Boffini2,3, Mauro Rinaldi2,3, Davide Ricci5. 1. Cardiovascular and Thoracic Department, Division of Cardiac Surgery, , Città Della Salute E Della Scienza", University of Turin, Corso Dogliotti, 14, Turin, Italy. cristina.barbero@unito.it. 2. Cardiovascular and Thoracic Department, Division of Cardiac Surgery, , Città Della Salute E Della Scienza", University of Turin, Corso Dogliotti, 14, Turin, Italy. 3. Department of Surgical Sciences, University of Turin, Turin, Italy. 4. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. 5. Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genoa, Italy.
Abstract
OBJECTIVE: Custodiol® and St. Thomas cardioplegia are widely employed in mini-thoracotomy mitral valve (MV) operations. One-dose of the former provides 3 h of myocardial protection. Conversely, St. Thomas solution is usually reinfused every 30 min and safety of single delivery is unknown. We aimed to compare single-shot St. Thomas versus Custodiol® cardioplegia. METHODS: Primary endpoint of the prospective observational study was cardiac troponin T level at different post-operative time-points. Propensity-weighted treatment served to adjust for confounding factors. RESULTS: Thirty-nine patients receiving St. Thomas were compared with 25 patients receiving Custodiol® cardioplegia; cross-clamping always exceeded 45 min. No differences were found in postoperative markers of myocardial injury. Ventricular fibrillation at the resumption of electric activity was more frequent following Custodiol® cardioplegia (P = .01). CONCLUSION: Effective myocardial protection exceeding 1 h of ischemic arrest can be achieved with a single-dose St. Thomas cardioplegia in selected patients undergoing right mini-thoracotomy MV surgery.
OBJECTIVE: Custodiol® and St. Thomas cardioplegia are widely employed in mini-thoracotomy mitral valve (MV) operations. One-dose of the former provides 3 h of myocardial protection. Conversely, St. Thomas solution is usually reinfused every 30 min and safety of single delivery is unknown. We aimed to compare single-shot St. Thomas versus Custodiol® cardioplegia. METHODS: Primary endpoint of the prospective observational study was cardiac troponin T level at different post-operative time-points. Propensity-weighted treatment served to adjust for confounding factors. RESULTS: Thirty-nine patients receiving St. Thomas were compared with 25 patients receiving Custodiol® cardioplegia; cross-clamping always exceeded 45 min. No differences were found in postoperative markers of myocardial injury. Ventricular fibrillation at the resumption of electric activity was more frequent following Custodiol® cardioplegia (P = .01). CONCLUSION: Effective myocardial protection exceeding 1 h of ischemic arrest can be achieved with a single-dose St. Thomas cardioplegia in selected patients undergoing right mini-thoracotomy MV surgery.
Authors: J James B Edelman; Michael Seco; Ben Dunne; Shannon J Matzelle; Michelle Murphy; Pragnesh Joshi; Tristan D Yan; Michael K Wilson; Paul G Bannon; Michael P Vallely; Jurgen Passage Journal: Ann Cardiothorac Surg Date: 2013-11