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Chirurgia 2016 June;29(3):69-72

lingua: Inglese

Simplified myocardial protective strategy in minimally invasive aortic valve procedures: early clinical results

Mohammed HASSAN 1, Ahmed MARAEY 2, Marco RICCI 1

1 Department of Surgery, Division of Cardiothoracic Surgery, University of New Mexico Health Science Center, Albuquerque, NM, USA; 2 Faculty of Medicine, Tanta University, Tanta, Egypt


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BACKGROUND: Minimally invasive aortic valve procedures via mini-sternotomy (mini-AVR) are gaining popularity. Myocardial protection in this setting may be provided by a variety of techniques including antegrade, direct antegrade, percutaneous retrograde, or retrograde through the operative field. Percutaneous techniques are time-consuming and potentially cumbersome. Herein we report the early clinical results of a simplified technique of myocardial protection.
METHODS: From 2013 to 2014, 25 patients underwent mini-AVR at our institution. Mini-AVR was performed via ministernotomy, direct aortic cannulation, femoral venous cannulation, and main pulmonary artery venting. Myocardial protection was provided by: 1) induction by infusion of blood cardioplegia (4:1 blood/crystalloid) through the aortic root; 2) maintenance via direct cardioplegic infusion into the left coronary ostium; 3) intermittent infusion of cold blood in the left coronary ostium whenever possible, in between maintenance cardioplegic doses. Peri-operative variables including changes in post-operative left ventricular ejection fraction (EF) were analyzed.
RESULTS: Of the 25 patients treated, 20 patients had aortic stenosis and 5 had aortic insufficiency. Patient demographics and relevant pre-operative, operative, and postoperative clinical variables were analyzed. Post-operative left ventricular EF measurements were unchanged as compared to pre-operatively (P=0.83). There were no mortalities or post-operative myocardial infarction.
CONCLUSIONS: Our findings in a limited cohort of patients undergoing mini-AVR via mini-sternotomy suggest that in selective patients with no concomitant coronary artery disease, this simplified strategy of induction and maintenance of myocardial protection is safe, and reproducible.

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