Time independent myocardial protection of single dose HTK cardioplegia: Comparison of conventional and minimally invasive mitral valve repair

Minimally invasive mitral valve surgery may require a prolonged period of myocardial ischemia. Cardioplegic solutions that necessitate a single dose for adequate myocardial protection are evoked to simplify surgery and result to be appealing in this setting. The aim of this study was to assess early outcomes after minimally invasive versus conventional mitral valve repair using one single dose of histidine-tryptophan-ketoglutarate solution (HTK; Custodiol) for myocardial protection. A retrospective analysis of prospectively collected data of patients who underwent primary isolated mitral valve repair between 2015–December 2021 was undertaken. Primary end-point was peak creatine kinase (CK)-MB within the first 24 hours after surgery. Secondary endpoints included operation and aortic cross-clamp times, in-hospital mortality, hospital and ICU stay, postoperative bleeding and rethoracotomy, and cumulative blood transfusion. All values are given as mean ± SD, P < 0.05 was considered as statistically significant. Analysis was performed by using the SPSS statistic software. 276 patients were included in the study (64 conventional vs. 272 minimally invasive procedure). Baseline patient characteristics did not differ between the groups except gender distribution (43.7% vs. 22.2% female, P = 0.02). There were no in-hospital death in the whole cohort. Operation and aortic cross-clamp times were significantly lower in the conventional group (208 ± 5 vs. 277 ± 4 min, P = 0.001 76 ± 20 vs 107 ± 26 min, P = 0.001, respectively). Peak CK-MB showed no significant differences between the groups (81 ± 53 vs. 76 ± 55 U/l). Postoperative measures did not differ between the groups. The present data confirms similar outcomes between conventional and minimally invasive mitral valve repair. Despite longer operation and aortic cross-clamp times, single dose cardioplegia with HTK solution provides a time independent excellent myocardial protection during minimally invasive surgery.