The Journal of Thoracic and Cardiovascular Surgery
Adult: Coronary: Basic ScienceComparison of del Nido and histidine-tryptophan-ketoglutarate cardioplegic solutions in minimally invasive cardiac surgery
Graphical abstract
The scheme of a retrospective study on comparison of DN and HTK cardioplegic solutions in minimally invasive cardiac surgery. Propensity score matching yielded 228 pairs of patients, and no significant intergroup differences in postoperative clinical outcomes and early adverse outcomes were found. However, peak cardiac enzyme levels were significantly lower in the DN group until the crossover point at the cardiac ischemic time over 100 minutes.
Section snippets
Study Population
The study identified a total of 1014 adult patients (age ≥ 17 years) who underwent cardiac surgery through a minimally invasive approach requiring cardiac arrest with HTK or DN cardioplegic solutions from May 2015 to February 2019 in the Institutional Cardiac Surgical Database of Asan Medical Center, Seoul, Korea. MICS was defined as a cardiac operation requiring cardiac arrest, which is performed through right lateral minithoracotomy, right anterior minithoracotomy, or partial sternotomy
Baseline Characteristics
The baseline characteristics of the overall cohort are summarized in Table 1. In comparison with patients in the HTK group, patients in the DN group were older (P = .012) and had greater left ventricular (LV) mass (P = .002). The proportions of patients with male gender (P = .029), diabetes (P = .001), and hypertension (P = .032) were higher in the DN group. Other baseline profiles, including European System for Cardiac Operative Risk Evaluation II, did not show statistically significant
Discussion
The present study found that the use of DN and HTK showed similar safety in MICS. Early clinical outcomes and major adverse outcomes showed no significant differences between the 2 groups. Postoperative serum lactic acid levels and postoperative VIS were used as indicators of postoperative hemodynamic stability, and these also did not show significant differences between the 2 groups. Although DN and HTK cardioplegic solutions consist of discrete electrolytes and buffering agents (extracellular
Conclusions
In comparison with HTK cardioplegic solution, DN cardioplegic solution seems to have acceptable safety and efficacy with good myocardial protection in the setting of MICS.
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Institutional Review Board approval: 2020-02-04, S2019-0421-0002
C-h.L and Y.K. contributed equally as first authors to this study. J.W.L. and J.B.K. have contributed equally as corresponding authors to this study.