Celsior®crystalloid Cardioplegia Versus Standard Hyperkalemic Normothermic Blood Cardioplegia: Analysis of Myocardial Protection in Elective Mitral Valve Repair

Introduction: With the increase and refinement of video assisted mitral valve surgery, cristalloid cardioplegia started regaining popularity. The aim of our study was to evaluate the effectiveness of Celsior(R), a crystalloid cardioplegic solution, on myocardial protection in elective surgical mitral valve repair in comparison to blood based hyperkalemic cardioplegia. Methods: In this observational retrospective study, all consecutive elective isolated surgical mitral valve repair where Celsior(R) or normothermic hyperkalemic blood cardioplegia were used were included. Primary endpoint was any sign of myocardial protection failure (troponin levels, need for inotropic or mechanical support, rhythm disturbances, mortality). Secondary endpoint was Celsior(R) safety (allergic reactions, bleeding, organ toxicities). Results: From January 2009 to August 2016, 382 patients underwent elective isolated mitral valve repair in whom normothermic hyperkalemic blood cardioplegia (n = 181) or Celsior(R) (n = 201) were used. There were no statistically significant differences in baseline characteristics including Euroscore 2. Peak troponin (pg/ml) release and 30-days mortality were not statistically different. Need for cardioversion was significantly more frequent in the Celsior(R) group (47% vs 13%, p < 0.001). There was no statistical difference in post-operative atrial fibrillation, permanent pacemaker implantation, reoperation for bleeding, transfusion, acute kidney injury, haemoglobin at discharge or length of stay. No allergic reaction to Celsior(R) occurred. Conclusion: Effective myocardial protection was achieved with the Celsior(R) cardioplegic solution with no unexpected toxicity. Celsior(R) may be an efficacious and safe cardioprotective strategy in mitral valve repair.