# Safety of Custodiol for Myocardial Protection in Minimally Invasive Mitral Valve Repair: A Japanese Single-Center Retrospective Comparison with Blood Cardioplegia in Conventional Sternotomy Repair

## TL;DR

This study compares the safety of Custodiol in minimally invasive heart surgery to traditional blood cardioplegia in Japan, finding similar heart protection.

## Contribution

The study provides new evidence on Custodiol's safety in minimally invasive mitral valve repair in an Asian population.

## Key findings

- Custodiol resulted in significantly lower creatine kinase-MB levels post-surgery compared to blood cardioplegia.
- Left ventricular ejection fraction was comparable between the two groups before and after surgery.
- Myocardial protection with Custodiol was non-inferior to repetitive cold blood cardioplegia in open repair.

## Abstract

Research regarding Custodiol’s safety in minimally invasive mitral valve repair remains limited in Asian populations. We compared Custodiol in minimally invasive mitral valve repair to repetitive cold blood cardioplegia in open mitral valve repair.

We retrospectively evaluated 98 consecutive patients who underwent minimally invasive mitral valve repair with Custodiol and 70 consecutive patients who underwent open mitral valve repair with repetitive cold blood cardioplegia at our institution between January 2015 and December 2024. The primary endpoints were creatine kinase-myocardial band (MB) levels and left ventricular ejection fraction determined by echocardiography pre- and post-surgery.

Maximum creatine kinase-MB levels within 48 h post-surgery were significantly lower in the minimally invasive group than in the open repair group, both in the overall cohort (45.0 vs. 60.7 U/L; p <0.001, respectively) and after excluding patients who underwent Maze procedure or pulmonary vein isolation (42.4 vs. 50.0 U/L; p = 0.009, respectively). Left ventricular ejection fraction pre- and post-surgery was comparable between the minimally invasive and open repair groups (72% vs. 69%; p = 0.426 and 59% vs. 60%; p = 0.204, respectively).

Custodiol during minimally invasive mitral valve repair provides myocardial protection comparable to repetitive cold blood cardioplegia in open mitral valve repair.