Myocardial Protection in Cardiac Surgery: Del Nido Versus Blood Cardioplegia

Overview

Journal Ann Card Anaesth

Specialty Anesthesiology

Date 2020 Oct 28

PMID 33109807

Citations 10

Authors

Gladdy George

A V Varsha

Madhu Andrew Philip

Reshma Vithayathil

Dharini Srinivasan

F X Sneha Princy

Raj Sahajanandan

Affiliations

Soon will be listed here.

Abstract

Objectives: del Nido cardioplegia which was traditionally used for myocardial protection in pediatric congenital heart surgery is now being extensively utilized in adult cardiac surgery. The aim of this study was to compare the safety and efficacy of del Nido cardioplegia (DNC) with blood cardioplegia (BC).

Materials And Methods: This is a historical cohort study using secondary data. Two hundred and eighty six patients who underwent coronary artery bypass graft (CABG) or valve surgery were included. They were divided into 2 matched cohorts of which 143 patients received BC and 143 patients received DNC.

Results: There was no difference in cardiopulmonary bypass time (P = 0.516) and clamp time (P = 0.650) between the groups. The redosing of cardioplegia was significantly less for DNC (1.13 vs. 2.35, P = <0.001). The post bypass hemoglobin was higher for DNC (9.1 vs. 8.7, P = 0.011). The intraoperative and postoperative blood transfusion was comparable (P = 0.344) (P = 0.40). The incidence of clamp release ventricular fibrillation (P = 0.207) was similar. The creatine kinase-MB isotype levels for the CABG patients were comparable on all 3 days (P = 0.104), (P = 0.106), and (P = 0.158). The postoperative left ventricle ejection fraction was lesser but within normal range in the DNC group (53.4 vs. 56.0, P = <0.001). The duration of ventilation (P = 0.186), ICU days (P = 0.931), and postoperative complications (P = 0.354) were comparable. There was no 30-day mortality or postoperative myocardial infarction in both the groups.

Conclusion: DNC provides equivalent myocardial protection, efficacy, and surgical workflow and had comparable clinical outcomes to that of BC. This study shows that DNC is a safe alternate to BC in CABG and valve surgeries.

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References

Ad N, Holmes S, Massimiano P, Rongione A, Fornaresio L, Fitzgerald D . The use of del Nido cardioplegia in adult cardiac surgery: A prospective randomized trial. J Thorac Cardiovasc Surg. 2017; 155(3):1011-1018. PMC: 5929134. DOI: 10.1016/j.jtcvs.2017.09.146. View

Hamad R, Nguyen A, Laliberte E, Bouchard D, Lamarche Y, El-Hamamsy I . Comparison of del Nido Cardioplegia With Blood Cardioplegia in Adult Combined Surgery. Innovations (Phila). 2017; 12(5):356-362. DOI: 10.1097/IMI.0000000000000403. View

Teman N, Delavari N, Romano M, Prager R, Yang B, Haft J . Effects of autologous priming on blood conservation after cardiac surgery. Perfusion. 2014; 29(4):333-339. DOI: 10.1177/0267659113517923. View

Buel S, Whittaker Striker C, OBrien J . del Nido versus St. Thomas Cardioplegia Solutions: A Single-Center Retrospective Analysis of Post Cross-Clamp Defibrillation Rates. J Extra Corpor Technol. 2016; 48(2):67-70. PMC: 5001523. View

Habertheuer A, Kocher A, Laufer G, Andreas M, Szeto W, Petzelbauer P . Cardioprotection: a review of current practice in global ischemia and future translational perspective. Biomed Res Int. 2014; 2014:325725. PMC: 4172998. DOI: 10.1155/2014/325725. View

Vistarini N, Laliberte E, Beauchamp P, Bouhout I, Lamarche Y, Cartier R . Del Nido cardioplegia in the setting of minimally invasive aortic valve surgery. Perfusion. 2016; 32(2):112-117. DOI: 10.1177/0267659116662701. View

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

Gundry S, Sequeira A, Coughlin T, McLAUGHLIN J . Postoperative conduction disturbances: a comparison of blood and crystalloid cardioplegia. Ann Thorac Surg. 1989; 47(3):384-90. DOI: 10.1016/0003-4975(89)90378-0. View

Spellman J . Pro: In Favor of More Generalized Use of del Nido Cardioplegia in Adult Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth. 2018; 33(6):1785-1790. DOI: 10.1053/j.jvca.2018.01.041. View

10.

Guajardo Salinas G, Nutt R, Rodriguez-Araujo G . Del Nido cardioplegia in low risk adults undergoing first time coronary artery bypass surgery. Perfusion. 2016; 32(1):68-73. DOI: 10.1177/0267659116661051. View

11.

Chatrath R, Kaul T, Walker D . Myocardial protection during cardioplegia in open-heart surgery: a review. Can Anaesth Soc J. 1980; 27(4):381-8. DOI: 10.1007/BF03007460. View

12.

Hofmann B, Kaufmann C, Stiller M, Neitzel T, Wienke A, Silber R . Positive impact of retrograde autologous priming in adult patients undergoing cardiac surgery: a randomized clinical trial. J Cardiothorac Surg. 2018; 13(1):50. PMC: 5963082. DOI: 10.1186/s13019-018-0739-0. View

13.

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

14.

Zeng J, He W, Qu Z, Tang Y, Zhou Q, Zhang B . Cold blood versus crystalloid cardioplegia for myocardial protection in adult cardiac surgery: a meta-analysis of randomized controlled studies. J Cardiothorac Vasc Anesth. 2014; 28(3):674-81. DOI: 10.1053/j.jvca.2013.06.005. View

15.

Ali J, Miles L, Abu-Omar Y, Galhardo C, Falter F . Global Cardioplegia Practices: Results from the Global Cardiopulmonary Bypass Survey. J Extra Corpor Technol. 2018; 50(2):83-93. PMC: 6002645. View

16.

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

17.

Ota T, Yerebakan H, Neely R, Mongero L, George I, Takayama H . Short-term outcomes in adult cardiac surgery in the use of del Nido cardioplegia solution. Perfusion. 2015; 31(1):27-33. DOI: 10.1177/0267659115599453. View

18.

ODonnell C, Wang H, Tran P, Miller S, Shuttleworth P, Boyd J . Utilization of Del Nido Cardioplegia in Adult Coronary Artery Bypass Grafting　- A Retrospective Analysis. Circ J. 2018; 83(2):342-346. DOI: 10.1253/circj.CJ-18-0780. View

19.

Engoren M, Habib R, Zacharias A, Schwann T, Riordan C, Durham S . The association of elevated creatine kinase-myocardial band on mortality after coronary artery bypass grafting surgery is time and magnitude limited. Eur J Cardiothorac Surg. 2005; 28(1):114-9. DOI: 10.1016/j.ejcts.2005.03.004. View

20.

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