Myocardial protection using HTK solution in minimally invasive mitral valve surgery

Background: Minimally invasive cardiac surgery (MICS) is a safe and satisfactory approach used mainly in mitral valve surgery with excellent results in many centers. Cardioplegia administration can be still a problem, especially when an endoaortic clamp is used. We retrospectively analyzed our early results with histidine-triptophane-ketoglutarate (HTK) solution used for myocardial protection in MICS. Methods: Between February 2003 and February 2004, 8 patients underwent mitral valve surgery using an endocardiopulmonary bypass (CPB) system and HTK solution as myocardial protection. The mean patient age was 67.7 \ub1 9.2 years, and the preoperative ejection fraction was normal in all patients. Three patients had valve repair and 5 had valve replacement. Mean CPB time was 129.2 \ub1 19.4 minutes, and aortic cross-clamp duration was 88.5 \ub1 15.4 minutes. Results: In every case HTK solution was used for only a single dose for cardioplegia at the beginning of the procedure, without any recalls. The heart restarted spontaneously at reperfusion in 6 of 8 cases (75%), and there were no significant modifications in electrocardiogram results or myocardial cytonecrosis enzymes (creatine kinase and its MB fraction) during the postoperative period. Conclusions: HTK solution is a cold crystalloid cardioplegia solution that has demonstrated its utility in MICS because it provides a safe long cardioplegic arrest time and it reduces the risk of inadequate coronary perfusion due to dislodgement of the endoaortic clamp. \ua9 2004 Forum Multimedia Publishing, LLC