Del Nido cardioplegia offers equivalent myocardial protection and clinical outcomes
to blood cardioplegia in adult isolated CABG and valve patients, but the safety and
efficacy of del Nido in complex cases with prolonged aortic cross-clamp times is still
unknown. 443 patients at our center underwent replacement of the ascending aorta using
either del Nido (n = 182) or blood (n = 261) cardioplegia. Two surgeons used del Nido
exclusively and 6 used blood exclusively over the study period. Propensity matching
of preoperative characteristics yielded 172 well matched pairs. Emergency and reoperative
cases were included. Clinical data were extracted from our local database. Troponin
levels were drawn at 12 hours postop in all patients. Rates of perioperative mortality
(4.7% vs 5.2%), stroke (5.8% vs 7.0%), renal failure (11.6% vs 12.2%), atrial fibrillation
(36.0% vs 31.4%), intra-aortic balloon pump insertion (2.3% vs1.2%), and extra corporeal
membrane oxygenation use (4.7% vs 4.1%) did not differ between blood and del Nido
groups. Postop Troponin T levels were 0.50[0.35, 0.86] ng/mL and 0.40[0.20, 0.70]
ng/mL for blood and del Nido, respectively (P < 0.0001). Postop echocardiography was available in 333 of 344 (96.8%) patients,
and there was no difference in change in EF from pre- to postop between blood 0.0[-6.0,
5.0]% and del Nido 0.0 [-6.0, 3.5]% (P = 0.201). Subgroup analysis of patients with aortic cross-clamp time greater than
180 minutes (blood = 77, del Nido = 27) revealed no difference in troponins, ejection
fraction, or clinical outcomes. Five-year survival was 85.9[76.8, 91.7]% and 79.8[71.2,
86.1]% for blood and del Nido, respectively (P = 0.151). In ascending aortic surgery with prolonged operative times, no differences
were observed in myocardial protection or clinical outcomes with the use of del Nido
cardioplegia compared to blood cardioplegia.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
AXC (Aortic cross-clamp), BC (Blood cardioplegia), DC (Del Nido cardioplegia), EF (Left ventricular ejection fraction), ECMO (Extracorporeal Membrane Oxygenation), IABP (Intra-aortic balloon pump), LV (Left ventricle), STS (Society of Thoracic Surgeons)To read this article in full you will need to make a payment
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References
- Myocardial protection using del Nido cardioplegia solution in adult re-operative aortic valve surgery.J Cardiac Surg. 2014; 29: 445-449
- The del Nido versus cold blood cardioplegia in aortic valve replacement: A randomized trial.J Thorac Cardiovasc Surg. 2020; 159: 2275-2283
- Del Nido cardioplegia can be safely administered in high risk coronary artery bypass grafting surgery after acute myocardial infarction: A propensity matched comparison.J Cardiothorac Surg. 2014; 9: 141
- Del Nido versus Buckberg cardioplegia in adult isolated valve surgery.J Thorac Cardiovasc Surg. 2015; 149: 626-636
- Del Nido cardioplegia versus blood cardioplegia in adult aortic root surgery.J Thorac Cardiovasc Surg. 2020; (Article in Press): 1-9
- Single-dose del Nido cardioplegia in minimally invasive aortic valve surgery.Semin Thorac Cardiovasc Surg. 2017; 29: 471-476
- Propensity matched analysis of del Nido cardioplegia in adult coronary artery bypass grafting: Initial experience with 100 consecutive patients.Ann Thorac Surg. 2016; 101: 2237-2241
- Del Nido cardioplegia in isolated adult coronary artery bypass surgery.J Thorac Cardiovasc Surg. 2020; 160: 1479-1485
- Single dose myocardial protection techniques utilizing del Nido cardioplegia solution during congenital heart surgery procedures.Perfusion. 2012; 27: 98-103
- del Nido cardioplegia in adult cardiac surgery: Beyond single-valve surgery.Interact Cardiovasc Thorac Surg. 2018; 27: 81-87
- National Academy of clinical biochemistry laboratory medicine practice guidelines: Clinical characteristics and utilization of biochemical markers in acute coronary syndrome.Circulation. 2007; 115: e356-e375
- Protecting the aged heart during cardiac surgery: Use of del Nido cardioplegia provides superior functional recovery in isolated hearts.J Thorac Cardiovasc Surg. 2013; 146: 940-948
- Del Nido cardioplegia in low risk adults undergoing first time coronary artery bypass surgery.Perfusion. 2017; 32: 68-73
- The use of del Nido cardioplegia in adult cardiac surgery: A prospective randomized trial.J Thorac Cardiovasc Surg. 2018; 155: 1011-1018
- Del Nido cardioplegia for myocardial protection in adult cardiac surgery: A systemic review and meta-analysis.ASAIO J. 2018; 64: 360-367
- Single- versus multidose cardioplegia in adult cardiac surgery patients: A meta-analysis.J Thorac Cardiovasc Surg. 2020; 160: 1195-1202
- Use of del Nido cardioplegia for adult cardiac surgery at the Cleveland Clinic: Perfusion implications.J Extra Corporeal Technol. 2014; 46: 317-323
- Transitioning to del Nido cardioplegia for all-comers: The next switching gear?.BMC Cardiovasc Disord. 2020; 20: 215
- Superior restoration of left ventricular performance after prolonged single-dose del Nido cardioplegia in conjunction with terminal warm blood cardioplegic reperfusion.J Thorac Cardiovasc Surg. 2021; (Journal Pre-proof. online ahead of print)
Article info
Publication history
Published online: October 27, 2021
Footnotes
Financial Support: Internal institutional funds were used to support this study and no conflict of interest is associated with this investigation
Spectrum Health IRB 2018-114 Approved January 15, 2020. The Institutional Review Board (IRB) of Spectrum Health approved the study protocol and publication of data. Patient written consent for the publication of the study data was waived by the IRB as no patient protected health information was included for publication.
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