Myocardial protection is a major issue in cardiac surgery, since inadequate protection increases the risk of postoperative cardiac dysfunction. The main principle of myocardial protection in cardiac surgery is to preserve myocardial function by preventing ischemia with blood cardioplegia . Previous studies have shown that adenosine as an adjunct to blood cardioplegia can be safely used in cardiac surgery. In the Amphia Hospital, adenosine is already used as standard care as an initial cardioplegic bolus in minimally invasive port access operations. Whether, adenosine as an adjunct to intermittent warm blood cardioplegia, has an added value remains unclear. Therefore the investigators would like to investigate the effect of the addition of adenosine to standard intermittent warm blood cardioplegia in patients scheduled for minimally invasive, port access operations (mitral valve surgery). Half of the participants will receive standard intermittent warm blood cardioplegia, while the other half will receive intermittent warm blood cardioplegia enriched with adenosine.
Myocardial protection is a major issue in cardiac surgery, since inadequate protection increases the risk of postoperative cardiac dysfunction. The main principle of myocardial protection in cardiac surgery is to preserve myocardial function by preventing ischemia with blood cardioplegia . Previous studies have shown that adenosine as an adjunct to blood cardioplegia can be safely used in cardiac surgery. In the Amphia Hospital, adenosine is already used as standard care as an initial cardioplegic bolus in minimally invasive port access operations. Whether, adenosine as an adjunct to intermittent warm blood cardioplegia, has an added value remains unclear. Therefore the investigators would like to investigate whether the addition of adenosine to standard intermittent warm blood cardioplegia reduces the 6-hours post-operative cardiac troponin T (cTnT) in patients scheduled for minimally invasive, port access operations (mitral valve surgery).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
100
This group receives intermittent warm blood cardioplegia enriched with adenosine
Amphia Hospital
Breda, North Brabant, Netherlands
RECRUITING6-hour cardiac Troponin T (cTnT) release
The primary end point is 6-hour cTnT release
Time frame: 6 hours post-operative
18-hour cardiac Troponin T (cTnT) area under the curve (AUC) release
18-hour postoperative AUC release of cardiac troponin T Routine blood samples pre-operatively from peripheral blood (T0); post-operatively, from peripheral blood, at arrival at ICU (T1) and 6 hours after arrival at ICU (T2), and 18 hours after arrival at ICU (T3).
Time frame: cardiac Troponin T (cTnT) AUC will be assessed at different time points, the latest up to 18 hours after ICU arrival
Incidence of myocardial injury on 12-lead ECG
Incidence of myocardial injury on 12-lead ECG * New-onset Left bundle branch block (LBBB) * New-onset Q wave
Time frame: participants will be followed for the duration of ICU stay, an expected average of 2 days
Vasoactive-inotropic score
The hourly doses of the following inotropic and vasoactive medications are recorded for the first 18 h after post-operative admission to the ICU: dopamine, dobutamine, epinephrine, norepinephrine, milrinone and vasopressin.
Time frame: participants will be followed for the duration of ICU stay, an expected average of 2 days
Vasoconstrictor usage
Vasoconstrictor usage yes/no
Time frame: participants will be followed for the duration of ICU stay, an expected average of 2 days
Incidence of new onset Atrial fibrillation (AF)
Incidence of new onset AF
Time frame: participants will be followed for the duration of ICU stay, an expected average of 2 days
Routine blood samples
The amount of creatine kinase MB (CK-MB) and Creatinine at different time intervals. preoperatively from peripheral blood (T0); post-operatively, from peripheral blood, at arrival at ICU (T1) and 6 hours after arrival at ICU (T2)
Time frame: Routine blood samples will be assessed at different time points, the latest up to 6 hours after ICU arrival
Mean arterial pressure (MAP)
Haemodynamic monitoring
Time frame: participants will be followed for the duration of ICU stay, an expected average of 2 days
postoperative left ventricular ejection fraction (LVEF)
3-D transesophageal echocardiography (TEE) postoperative left ventricular ejection fraction (LVEF) after skin closure
Time frame: postoperative after skin closure, an expected average of 3 hours after starting surgery
Wall Motion Score Index (WMSI)
3-D transesophageal echocardiography (TEE) Wall Motion Score Index (WMSI) after skin closure
Time frame: postoperative after skin closure, an expected average of 3 hours after starting surgery
Heart rate (HR)
Haemodynamic monitoring. Heart rate will be measured in beats per minute (bpm).
Time frame: participants will be followed for the duration of ICU stay, an expected average of 2 days
Cardiac index (CI)
Cardiac index (CI) is a haemodynamic parameter that relates the cardiac output (CO) from left ventricle in one minute to body surface area (BSA)
Time frame: participants will be followed for the duration of ICU stay, an expected average of 2 days
Systemic vascular resistance index (SVRI)
SVRI = 80 x (MAP - RAP)/CI MAP = Mean Arterial Pressure (mmHg) RAP = Right Arterial Pressure (mmHg) CI = Cardiac Index (L/min/m2)
Time frame: participants will be followed for the duration of ICU stay, an expected average of 2 days
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