Single-Dose St. Thomas Versus Custodiol® Cardioplegia for Right Mini-thoracotomy Mitral Valve Surgery

Objective Custodiol (R) 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 (R) 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 (R) 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 (R) 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.

Automated summary

This study compared single-shot St. Thomas cardioplegia with Custodiol (R) cardioplegia in patients undergoing mini-thoracotomy mitral valve (MV) surgery. The results showed that single-dose St. Thomas cardioplegia can provide effective myocardial protection exceeding 1 hour of ischemic arrest in selected patients. No differences were found in postoperative markers of myocardial injury, but ventricular fibrillation was more frequent following Custodiol (R) cardioplegia at the resumption of electric activity.