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Simplified Myocardial Protection In Minimally Invasive Mitral Valve Surgery
Yoshitsugu Nakamura1, Takaki Hori1, Takashi Murakami1, Yujiro Ito1, Yujiro Hayashi1, Yohei Kawatani1, Hiroshi Niinami2, Hiroyuki Nakajima2.
1Chibanishi general hospital, Chiba, Japan, 2Saitama Medical University International Medical Center, Saitamai, Japan.

OBJECTIVE: In minimally invasive mitral valve surgery (MIMVS) via a right minithoracotomy approach, delivery of cardioplegia is relatively challenging because of technically demanding retrograde cardioplegia or troublesome changes of the mitral valve exposure for antegrade cardioplegia. Therefore we utilized crystalloid intracellular-type cardioplegia to diminish repeats of carioplegia delivery for MIMVS. This study reports its outcomes and efficacy. METHODS: 27 patients underwent MIMVS using crystalloid intracellular-type cardioplegia from December 2011 to December 2013. The mean age was 59+/-11 years old and 14 patients were male. All patients had moderate or severe mitral regurgitation Mean preoperative ejection fraction was 68+/-7. The cardioplegia was delivered by antegradely through the aortic root cannula and the root cannula was disconnected from plegia-lines and left into the pleural cavity to save the working space. The second cardioplegia was given if arrest time prolonged over 150 min. RESULTS: All patients underwent mitral valve repair and mitral regurgitation improve to less than mild. Cardiac arrest time and cardiopulmonary time were 131+/-26 min and 172+/-34 min, respectively. The mean volume of cardioplegia was 2037+/-192 ml. Mitral valve repair was successfully completed in all patients. Only 1 patient (4%) needed 2nd delivery of cardioplegia. There was no failure to wean cardiopulmonary bypass. No hospital mortality was observed. The mean intubation time was 18.9 hours and postoperative creatine kinase MB was 30.1 μg/ml. Mean postoperative ejection fraction was 60+/-12. CONCLUSIONS: Simplified myocardial protection with crystalloid intracellular-type cardioplegia was feasible method for MIMVS.

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