ABSTRACT
OBJECTIVE: Single-dose antegrade crystalloid cardioplegia with Custodiol-HTK (histidine-tryptophan-ketoglutarate) has been used for many years. Its safety and efficacy were established in experimental and clinical studies. It is beneficial in complex valve surgery because it provides a long period of myocardial protection with a single dose. Thus, valve procedures (minimally invasive or open) can be performed with limited interruption. The aim of this study is to compare the use of Custodiol-HTK cardioplegia with traditional blood cardioplegia in patients undergoing minimally invasive and open valve surgery. METHODS: A single-institution, retrospective case-control review was performed on patients who underwent valve surgery in Lee Memorial Health System at either HealthPark Medical Center or Gulf Coast Medical Center from July 1, 2011, through March 7, 2015. A total of 181 valve cases (aortic or mitral) performed using Custodiol-HTK cardioplegia were compared with 181 cases performed with traditional blood cardioplegia. Each group had an equal distribution of minimally invasive and open valve cases. Right chest thoracotomy or partial sternotomy was performed on minimally invasive valve cases. Demographics, perioperative data, clinical outcomes, and financial data were collected and analyzed. RESULTS: Patient outcomes were superior in the Custodiol-HTK cardioplegia group for blood transfusion, stroke, and hospital readmission within 30 days (P < 0.05). No statistical differences were observed in the other outcomes categories. Hospital charges were reduced on average by $3013 per patient when using Custodiol-HTK cardioplegia. CONCLUSIONS: Use of Custodiol-HTK cardioplegia is safe and cost-effective when compared with traditional repetitive blood cardioplegia in patients undergoing minimally invasive and open valve surgery.
Subject(s)
Blood Transfusion/economics , Cardiac Surgical Procedures/methods , Cardioplegic Solutions/economics , Mitral Valve/surgery , Aged , Cardioplegic Solutions/administration & dosage , Case-Control Studies , Cost-Benefit Analysis , Female , Glucose/administration & dosage , Glucose/economics , Heart Arrest, Induced/economics , Heart Arrest, Induced/methods , Humans , Male , Mannitol/administration & dosage , Mannitol/economics , Minimally Invasive Surgical Procedures , Potassium Chloride/administration & dosage , Potassium Chloride/economics , Procaine/administration & dosage , Procaine/economics , Retrospective Studies , Treatment OutcomeABSTRACT
Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection.
Subject(s)
Cardiac Surgical Procedures/methods , Heart Valve Diseases/surgery , Mitral Valve/surgery , Heart Valve Diseases/diagnostic imaging , Humans , Minimally Invasive Surgical Procedures/methods , Mitral Valve/diagnostic imaging , Patient Selection , Practice Guidelines as Topic , Preoperative Period , Radiography, ThoracicABSTRACT
Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery.
Subject(s)
Cardiac Surgical Procedures/methods , Heart Valve Diseases/surgery , Minimally Invasive Surgical Procedures/methods , Mitral Valve/surgery , Endoscopy/methods , Humans , Patient Selection , Postoperative Care , Practice Guidelines as Topic , Robotic Surgical Procedures/methods , Sternotomy/methods , Thoracotomy/methods , Treatment OutcomeABSTRACT
Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program.