Myocardial protection in thoracoscopic mitral valve surgery: Bretschneider versus Calafiore solution

Objectives: Thoracoscopic mitral valve surgery via right thoracotomy has increasing impact in clinical routine. The best strategy of myocardial protection for these patients is in discussion. Whereas warm blood cardioplegia of Calafiore (group C) is well established in coronary surgery the cold crystalloid cardioplegia of Bretschneider (Custodiol, group B) is the protection of choice for procedures with long ischemia time. Methods: A consecutive series of 100 patients underwent mitral surgery were prospectively randomized for the two myocardial protection strategies described above. Quality of myocardial protection was evaluated using the specific ischemia markers cTNI and CK-MB, respectively. Demographic as well as operative data did not show any differences between the groups. Results: The 30d mortality rate was 3.4% for group B and 6.6% for group C (p=0.287). Mean cTNI levels (p=0.02) as well as CK-MB levels (p=0.026) were significantly higher in group C compared to group B (ANOVA for repeated measurements). However, need for defibrillation was higher after Bretschneider cardioplegia (39% vs. 10%, p=0.031). Conclusion: This prospective study suggests the superiority of myocardial protection by Bretschneider cardioplegia compared to Calafiore cardioplegia in minimally invasive mitral valve surgery.