Del Nido Cardioplegia in Surgery for Aortic Root Disease: a Historically Controlled Study

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2020 Sep 18

PMID 32944322

Citations 2

Authors

Hui Shi

Haiyan Luo

Xiaomin Qi

Hui Zhao

Chaoqi Liu

Hongsong Chen

Runsheng Peng

Zhangsheng Yu

Kejian Hu

Xin Li

Chunsheng Wang

Affiliations

Soon will be listed here.

Abstract

Background: To determine the safely and effectively of del Nido cardioplegia (DNC) in surgery for aortic root disease, with mild hypothermic cardiopulmonary bypass (CPB).

Methods: From July to December 2017, all patients undergoing the surgery for aortic root disease (total aortic root replacement, valve-sparing aortic root replacement and replacement of aortic valve plus ascending aorta), with mild hypothermic CPB, were retrospectively reviewed at our institution. Patients were divided into two groups based on the type of cardioplegia: the classical blood cardioplegia (CBC group) and del Nido cardioplegia (DNC group). Demographics, operative details, perioperative data and postoperative complications were recorded and compared. A propensity score matching was performed in this study.

Results: The preoperative data in DNC group were similar to CBC group. The volume of ultrafiltration was lower in DNC than CBC group (2,053.49±806.62 DNC . 2,666.00±967.14 CBC, P=0.001), when matched. The use of temporary pacemaker was more in DNC group (n=20, 46.5%, P=0.023), and the rate of automatic heart resuscitating was higher in the CBC group (92.0% . 72.1% DNC group, P=0.024, unmatched).There were no differences in in-hospital mortality, troponin T (mean 0.66 ng/mL for CBC group . 0.49 ng/mL for DNC group, P=0.152), left ventricular ejection fraction (mean 58.37% for CBC group . 60.07% for DNC group, P=0.395) or other postoperative complications between two groups, after matching. In subgroup analysis, the ultrafiltration volume was lower in DNC than CBC group (1,932.26±749.39 DNC . 2,640.00±996.24 CBC, P=0.004), when ACC time less than or equal to 90 minutes. The apache score was better in DNC group (4.75±3.41, P=0.041), when ACC time greater than 90 min. There were no statistical significances in other characteristics between groups.

Conclusions: DNC is safe and effective for surgery for aortic root disease, not inferior to the CBC.

Citing Articles

Outcomes of Del Nido and hyperkalemic blood cardioplegia in adult cardiac surgery with prolonged aortic cross-clamp times★.

Szpytma M, Gimpel D, Ross J, Newland R, Crouch G, Rice G J Extra Corpor Technol. 2024; 56(4):149-158.

PMID: 39705579 PMC: 11661786. DOI: 10.1051/ject/2024029.

Protective Efficacy on Adult Ischemic Myocardium under Bypass: Del Nido vs. St. Thomas Blood Cardioplegia.

Zhang X, Du Y, Wang A Ann Thorac Cardiovasc Surg. 2022; 29(3):125-132.

PMID: 36543178 PMC: 10284662. DOI: 10.5761/atcs.oa.22-00144.

References

Koeckert M, Smith 3rd D, Vining P, Ranganath N, Beaulieu T, Loulmet D . Del Nido cardioplegia for minimally invasive aortic valve replacement. J Card Surg. 2018; 33(2):64-68. DOI: 10.1111/jocs.13536. View

Carmo H, Reichert K, Carvalho D, Silveira-Filho L, Vilarinho K, Oliveira P . Lidocaine and Pinacidil Added to Blood versus Crystalloid Cardioplegic Solutions: Study in Isolated Hearts. Braz J Cardiovasc Surg. 2018; 33(3):211-216. PMC: 6089128. DOI: 10.21470/1678-9741-2017-0244. View

Kucinski J, Gorska A, Deja M . Del Nido cardioplegia as a safe and effective method of myocardial protection in adult patients undergoing cardiac surgery: a single‑center experience. Kardiol Pol. 2019; 77(11):1040-1046. DOI: 10.33963/KP.14964. View

Mick S, Robich M, Houghtaling P, Gillinov A, Soltesz E, Johnston D . del Nido versus Buckberg cardioplegia in adult isolated valve surgery. J Thorac Cardiovasc Surg. 2014; 149(2):626-634. DOI: 10.1016/j.jtcvs.2014.10.085. View

Sorabella R, Akashi H, Yerebakan H, Najjar M, Mannan A, Williams M . Myocardial protection using del nido cardioplegia solution in adult reoperative aortic valve surgery. J Card Surg. 2014; 29(4):445-9. PMC: 4297647. DOI: 10.1111/jocs.12360. View

OBlenes S, Hancock Friesen C, Ali A, Howlett S . Protecting the aged heart during cardiac surgery: the potential benefits of del Nido cardioplegia. J Thorac Cardiovasc Surg. 2010; 141(3):762-70. DOI: 10.1016/j.jtcvs.2010.06.004. View

Cayir M, Yuksel A . The Use of del Nido Cardioplegia for Myocardial Protection in Isolated Coronary Artery Bypass Surgery. Heart Lung Circ. 2019; 29(2):301-307. DOI: 10.1016/j.hlc.2018.12.006. View

Liu M, Jeong E, Liu H, Xie A, So E, Shi G . Magnesium supplementation improves diabetic mitochondrial and cardiac diastolic function. JCI Insight. 2019; 4(1). PMC: 6485371. DOI: 10.1172/jci.insight.123182. View

Buja L . Myocardial ischemia and reperfusion injury. Cardiovasc Pathol. 2005; 14(4):170-5. DOI: 10.1016/j.carpath.2005.03.006. View

10.

Valooran G, Nair S, Chandrasekharan K, Simon R, Dominic C . del Nido cardioplegia in adult cardiac surgery - scopes and concerns. Perfusion. 2015; 31(1):6-14. DOI: 10.1177/0267659115608936. View

11.

Yerebakan H, Sorabella R, Najjar M, Castillero E, Mongero L, Beck J . 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. PMC: 4220058. DOI: 10.1186/s13019-014-0141-5. View

12.

Powell Jr W, Dibona D, Flores J, Leaf A . The protective effect of hyperosmotic mannitol in myocardial ischemia and necrosis. Circulation. 1976; 54(4):603-15. DOI: 10.1161/01.cir.54.4.603. View

13.

Sanetra K, Pawlak I, Cisowski M . Del Nido cardioplegia - what is the current evidence?. Kardiochir Torakochirurgia Pol. 2018; 15(2):114-118. PMC: 6066678. DOI: 10.5114/kitp.2018.76477. View

14.

Kim K, Ball C, Grady P, Mick S . Use of del Nido Cardioplegia for Adult Cardiac Surgery at the Cleveland Clinic: Perfusion Implications. J Extra Corpor Technol. 2015; 46(4):317-23. PMC: 4557478. View

15.

Perrelli M, Pagliaro P, Penna C . Ischemia/reperfusion injury and cardioprotective mechanisms: Role of mitochondria and reactive oxygen species. World J Cardiol. 2011; 3(6):186-200. PMC: 3139040. DOI: 10.4330/wjc.v3.i6.186. View

16.

Luo H, Qi X, Shi H, Zhao H, Liu C, Chen H . Single-dose del Nido cardioplegia used in adult minimally invasive valve surgery. J Thorac Dis. 2019; 11(6):2373-2382. PMC: 6626819. DOI: 10.21037/jtd.2019.05.78. View

17.

Matte G, Del Nido P . History and use of del Nido cardioplegia solution at Boston Children's Hospital. J Extra Corpor Technol. 2012; 44(3):98-103. PMC: 4557532. View