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Malinowski M, Solarewicz M, Farley R, Salcido JR, Bush J, MacDoughall B, Bromberg-White J, Timek TA. Myocardial protection using single dose del Nido Cardioplegia with and without topical cooling. Perfusion 2024; 39:766-775. [PMID: 36842962 DOI: 10.1177/02676591231159507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Del Nido cardioplegia (DN) is gaining acceptance in adult cardiac surgery but there is paucity of experimental data regarding its efficacy. We set out to assess the safety and efficacy of single-dose DN with and without topical cooling (TC) versus multi-dose blood cardioplegia (BC). METHODS Thirty-two healthy adult sheep had pressure-volume (PV) catheters placed in the left (LV) and right (RV) ventricle. Animals were assigned to receive cold (4°C) antegrade solution for a 60-min arrest using: (1) multi-dose (every 20 min) BC with TC (n = 11), (2) single-dose DN with TC (DN-C, n = 10), or (3) single-dose DN without TC (DN-H, n = 11). LV and RV PV-derived indexes, epicardial echocardiographic strains, and blood samples were acquired before CPB and at 1, 2, and 3 h of reperfusion. Dobutamine bolus (2.5 μg) was given after 3 h to test for myocardial reserve. RESULTS Time to rhythm restoration was shortest (54 ± 29 s, 118 ± 167 s, and 172 ± 170 s for DN-H, DN-C, and BC, respectively; p = 0.024) and number of shocks lowest (1.7 ± 1.8, 3.6 ± 2.8, and 5.6 ± 4.6 for DN-H, DN-C, and BC, respectively; p = 0.020) in DN-H group. Hemodynamic, load-independent myocardial function, echocardiographic, and metabolic data revealed only slight differences between groups. Troponin I levels did not differ between groups. With dobutamine, preload-recruitable stroke work of both LV (136 ± 50%, 131 ± 31%, 142 ± 58% for BC, DN-C and DN-H, respectively; p = 0.993) and RV (161 ± 67%, 185 ± 45%, 166 ± 75% for BC, DN-C and DN-H respectively; p = 0.580) increased similarly. CONCLUSIONS Single-dose DN cardioplegia with or without topical cooling offered comparable biventricular myocardial protection to multi-dose BC for a 60-min arrest in sheep.
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Affiliation(s)
- Marcin Malinowski
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
- Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Monica Solarewicz
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Ryan Farley
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Jose Rios Salcido
- Division of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI, USA
| | - Jared Bush
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Brian MacDoughall
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | | | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
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James TM, Stamou SC, Faber C, Nores MA. Whole Blood del Nido versus Cold Blood Microplegia in Adult Cardiac Surgery: A Propensity-Matched Analysis. Int J Angiol 2024; 33:29-35. [PMID: 38352642 PMCID: PMC10861296 DOI: 10.1055/s-0039-3400747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objectives Few studies have evaluated the outcomes of whole blood microplegia in adult cardiac surgery. Our novel protocol includes removing the crystalloid portion and using the Quest Myocardial Protection System (MPS) for the delivery of del Nido additives in whole blood. This study sought to compare early and late clinical outcomes of whole blood del Nido microplegia (BDN) versus cold blood cardioplegia (CBC) following adult cardiac surgery. Materials and Methods A total of 361 patients who underwent cardiac surgery using BDN were compared with a contemporaneous control group of 934 patients receiving CBC. Propensity matching yielded 289 BDN and 289 CBC patients. Chi-square analysis and Fisher's exact test were performed to compare preoperative, operative, and postoperative characteristics on the matched data. Primary outcome was operative mortality, and secondary outcomes included clinical outcomes such as stroke, cardiac arrest, and intra-aortic balloon pump use. The Kaplan-Meier method was used to compare actuarial survival between the two groups using a log-rank test. Results After matching, preoperative characteristics and surgery type were similar between groups. Cardioplegia type did not affect the primary end point of operative mortality. The rate of postoperative intra-aortic balloon pump was lower in BDN patients compared with CBC patients (0 vs. 2%; p = 0.01). There was no difference in late survival. Conclusion Our novel protocol BDN was comparable with CBC, with similar clinical outcomes and no difference in operative mortality or actuarial survival. Further studies should evaluate the long-term outcomes of this technique.
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Affiliation(s)
- Taylor M. James
- Graduate Medical Education MD/MPH Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Sotiris C. Stamou
- Department of Cardiothoracic Surgery, JFK Medical Center, Atlantis, Florida
| | - Cristiano Faber
- Department of Cardiothoracic Surgery, JFK Medical Center, Atlantis, Florida
| | - Marcos A. Nores
- Department of Cardiothoracic Surgery, JFK Medical Center, Atlantis, Florida
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Osorio-Llanes E, Castellar-López J, Rosales W, Montoya Y, Bustamante J, Zalaquett R, Bravo-Sagua R, Riquelme JA, Sánchez G, Chiong M, Lavandero S, Mendoza-Torres E. Novel Strategies to Improve the Cardioprotective Effects of Cardioplegia. Curr Cardiol Rev 2024; 20:CCR-EPUB-137763. [PMID: 38275069 PMCID: PMC11071679 DOI: 10.2174/011573403x263956231129064455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/17/2023] [Accepted: 10/20/2023] [Indexed: 01/27/2024] Open
Abstract
The use of cardioprotective strategies as adjuvants of cardioplegic solutions has become an ideal alternative for the improvement of post-surgery heart recovery. The choice of the optimal cardioplegia, as well as its distribution mechanism, remains controversial in the field of cardiovascular surgery. There is still a need to search for new and better cardioprotective methods during cardioplegic procedures. New techniques for the management of cardiovascular complications during cardioplegia have evolved with new alternatives and additives, and each new strategy provides a tool to neutralize the damage after ischemia/reperfusion events. Researchers and clinicians have committed themselves to studying the effect of new strategies and adjuvant components with the potential to improve the cardioprotective effect of cardioplegic solutions in preventing myocardial ischemia/reperfusion-induced injury during cardiac surgery. The aim of this review is to explore the different types of cardioplegia, their protection mechanisms, and which strategies have been proposed to enhance the function of these solutions in hearts exposed to cardiovascular pathologies that require surgical alternatives for their corrective progression.
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Affiliation(s)
- Estefanie Osorio-Llanes
- Faculty of Exact and Natural Sciences, Grupo de Investigación Avanzada en Biomedicina, Universidad Libre Barranquilla, Atlantico, Colombia
| | - Jairo Castellar-López
- Faculty of Exact and Natural Sciences, Grupo de Investigación Avanzada en Biomedicina, Universidad Libre Barranquilla, Atlantico, Colombia
| | - Wendy Rosales
- Faculty of Exact and Natural Sciences, Grupo de Investigación Avanzada en Biomedicina, Universidad Libre Barranquilla, Atlantico, Colombia
| | - Yuliet Montoya
- Grupo de Dinámica Cardiovascular (GDC), Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - John Bustamante
- Grupo de Dinámica Cardiovascular (GDC), Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Ricardo Zalaquett
- Department of Cardiovascular Diseases, Faculty of Medicine, Universidad Finis Terrae - Clínica Las Condes, Santiago, Chile
| | - Roberto Bravo-Sagua
- Advanced Center for Chronic Diseases (ACCDiS), Faculty of Chemical and Pharmaceutical Sciences & Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Laboratorio OMEGA, INTA, University of Chile, Santiago, Chile
| | - Jaime A. Riquelme
- Advanced Center for Chronic Diseases (ACCDiS), Faculty of Chemical and Pharmaceutical Sciences & Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Gina Sánchez
- Physiopathology Program, Institute of Biomedical Sciences (ICBM), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Mario Chiong
- Advanced Center for Chronic Diseases (ACCDiS), Faculty of Chemical and Pharmaceutical Sciences & Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Sergio Lavandero
- Advanced Center for Chronic Diseases (ACCDiS), Faculty of Chemical and Pharmaceutical Sciences & Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Internal Medicine (Cardiology Division), University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Evelyn Mendoza-Torres
- Advanced Center for Chronic Diseases (ACCDiS), Faculty of Chemical and Pharmaceutical Sciences & Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Faculty of Health Sciences, Grupo de Investigación Avanzada en Biomedicina, Universidad Libre Seccional Barranquilla, Barranquilla, Colombia
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Di Bacco L, Rosati F, Repossini A, Baudo M, Renghini M, Maddinelli D, Boldini F, Zanin F, Tomasi C, Muneretto C, Benussi S. Del Nido cardioplegia in adult cardiac surgery: Clinical outcomes in a single center all-comer study. Perfusion 2023:2676591231211492. [PMID: 37944914 DOI: 10.1177/02676591231211492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
INTRODUCTION The use of Del Nido Cardioplegia (DNC) has been extended in the latest years from pediatrics to adult cardiac surgery with encouraging results. We sought to investigate clinical and biochemical outcomes in adult patients who underwent cardiac surgery with different degrees of complexity who received DNC for myocardial protection. METHODS Data on one-thousand patients were retrospectively collected from 2020 to 2022. The only exclusion criteria was off-pump adult cardiac surgery. Surgical procedures weight was categorized according EuroSCORE II in six groups: Single-CABG(G1), isolated non-CABG(mitral) (G2), isolated non-CABG(aortic) (G3), isolated non-CABG(any) (G4), 2-procedures(G5), 3/more-procedures(G6). Primary endpoint was to identify a binomial correlation between hs-TnT/CK-MB and the cross-clamp time (X-Clamp). A secondary endpoint was the comparison between the treatment groups of the vasoactive-inotropic score (VIS) and the need of mechanical circulatory support (MCS). RESULTS A linear correlation was identified between hs-TnT and X-clamp in the overall population (rho:0.447, p< .001) and in the treatment groups (G1:rho=0.357, p< .001/G2:rho=0.455, p< .001/G3:rho=0.307, p= .001/G4:rho=0.165, p= .257/G5:rho=0.157, p= .031/G6:rho=0.226, p= .015). Similarly, a linear correlation between CK-MB and X-clamp in the overall population (rho=0.457, p< .001) and treatment group (G1:rho=0.282, p< .001/G2:rho=0.287, p= .025/G3:rho=0.211, p= .009/G4:rho=0.0878, p= .548/G5:rho=0.309, p< .001/G6: rho=0.212, p= .024) was identified. As regard for the secondary endpoint, no differences were reported between the treatment groups in terms of VIS and MCS (VIS G1:7; G2:4; G3:7; G4:7, G5:5.5, G6:6, p-value= .691) (MCS G1: 4.5%; G2:4.8%; G3:3.3%; G4:3.1%; G5:1.4%; G6:5.3%; p-value= .372). CONCLUSIONS Del Nido Cardioplegia is a safe and useful tool in adult cardiac surgery allowing operators to achieve a stable and durable cardioplegic arrest. Despite accounting with different types of surgery, the six subgroups of our study population showed similar perioperative results.
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Affiliation(s)
- Lorenzo Di Bacco
- Division of Cardiac Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Fabrizio Rosati
- Division of Cardiac Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Alberto Repossini
- Division of Cardiac Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Massimo Baudo
- Division of Cardiac Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Mauro Renghini
- Division of Cardiac Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Debora Maddinelli
- Division of Cardiac Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Boldini
- Division of Cardiac Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Zanin
- Division of Cardiac Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Cesare Tomasi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Benussi
- Division of Cardiac Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
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(Del Nido cardioplegia in adult patients). COR ET VASA 2022. [DOI: 10.33678/cor.2021.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zhang X, Du Y, Wang A. Protective Efficacy on Adult Ischemic Myocardium under Bypass: Del Nido vs. St. Thomas Blood Cardioplegia. Ann Thorac Cardiovasc Surg 2022. [DOI: 10.5761/atcs.oa.22-00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Xueqin Zhang
- Department of Cardiac and Macrovascular Surgery, Suzhou Hospital of Anhui Medical University, Suzhou, China
| | - Yang Du
- Department of Cardiac Surgery, People’s Hospital of Jilin Province, Changchun, China
| | - Anhui Wang
- Department of Cardiac and Macrovascular Surgery, Suzhou Hospital of Anhui Medical University, Suzhou, China
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Eris C, Engin M, Erdolu B, Kagan As A. Comparison of del Nido Cardioplegia vs blood cardioplegia in adult aortic surgery is the single-dose cardioplegia technique really advantageous? Asian J Surg 2021; 45:1122-1127. [PMID: 34649799 DOI: 10.1016/j.asjsur.2021.09.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/14/2021] [Accepted: 09/20/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND /objective: The aim of the present study was to compare the operative and early postoperative results of the use of del Nido Cardioplegia solution (dNCS) with traditional blood cardioplegia (BC) in adult aortic surgery. METHODS A retrospective single-center study was performed on 118 patients who underwent aortic surgery with cardiopulmonary bypass (CPB) between January 2016 and June 2020. Patients were divided in to two groups according to the type of cardioplegia solution used. Cardiac arrest was achieved in Group 1 (n = 65) with traditional BC and in Group 2 (n = 53) with dNCS. Operative and postoperative outcomes of the patients were compared between the two groups. RESULTS Patient demographic characteristics were similar between the two groups. dNCS group showed significantly lower aortic cross-clamp (ACC) time (73.3 vs. 87.5 min, P = 0.001), cardioplegia volume (1323.9 ± 368.5 vs. 2773.8 ± 453.8 ml, P< 0.001), defibrillation rate (44.4%vs. 69.2%, P = 0.006), drainage amount (412 ± 73.2 vs. 446.9 ± 95.1 ml, P = 0.026) and inotropic support need (37% vs. 55.3%, P = 0.046). Also dNCS group had significantly lower high sensitive troponin I (hsTnI) levels at 6th (203.5 ± 68.6 vs. 275.7 ± 76.2 ng/L, P< 0.001) and 24th (253.1 ± 101 vs. 293.4 ± 80.1 ng/L, P = 0.017) postoperative hours. And dNCS group showed significantly higher hematocrit levels at 6th (25.1 ± 3.2 vs. 22.5 ± 2.5%, P< 0.001) and 24th (25.8 ± 2.7 vs. 24.6 ± 2.8%, P = 0.024) postoperative hours. Times of intensive care unit stay, durations of intuabation and hospital stay times were similar in both groups. There was no significant difference in terms of postoperative ejection fraction values (P = 0.714). CONCLUSION Compared with conventional BC, dNCS provided significantly shorter ACC times, reduced the need for intraoperative defibrillation, lowered postoperative hsTnI levels with comparable early clinical outcomes for adult patients undergoing aortic surgery. dNCS is a safe and efficient alternative to the traditional BC solution in adult aortic cardiac surgery.
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Affiliation(s)
- Cuneyt Eris
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovasculer Surgery, Mimar Sinan Town. Emniyet Street, Yıldırım, BURSA, Turkey.
| | - Mesut Engin
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovasculer Surgery, Mimar Sinan Town. Emniyet Street, Yıldırım, BURSA, Turkey.
| | - Burak Erdolu
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovasculer Surgery, Mimar Sinan Town. Emniyet Street, Yıldırım, BURSA, Turkey.
| | - Ahmet Kagan As
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovasculer Surgery, Mimar Sinan Town. Emniyet Street, Yıldırım, BURSA, Turkey.
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Sanetra K, Domaradzki W, Cisowski M, Białek K, Shrestha R, Bochenek A, Jankowska-Sanetra J, Buszman PP, Gerber W. Age- and gender-related differences in the del Nido cardioprotection protocol. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:502-509. [PMID: 34105925 DOI: 10.23736/s0021-9509.21.11710-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The evidence regarding the impact of patient's age and gender on del Nido cardioplegia cadioprotection capability in adults is strongly limited. METHODS A group of 75 patients undergoing aortic valve replacement (AVR) with del Nido cardioplegia was divided into Group 1 (male) and Group 2 (female). Creatine kinase (CK-MB isoenzyme) and high sensitivity troponin T (hs-TnT) values at 24 hours and 48 hours, occurrence of cardiac activity during crossclamp and ventricular fibrillation (VF) during reperfusion were compared. The impact of age on hs-TnT,CK-MB, VF during reperfusion and cardiac activity during crossclamp was investigated using regression models. RESULTS No difference between the groups was reported in 24-hour CK-MB (median 15.57 ng/ml; IQR 12.13-22.82 ng/mL vs 13.97; 12.09-17.147 ng/mL; p= .168), 48-hour CK-MB (6.19; 4.22-7.71 ng/mL vs 6.07;4.56-7.06 ng/mL; p= .707), 24-hour hs-TnT (259.2; 172.0-376.9 pg/mL vs 193.0; 167.8-351 pg/mL.1; p= .339), 48-hour hs-TnT (169.1; 124.9-293.0 pg/mL vs 159.2; 123.12-211.77 pg/mL; p= .673), VF during reperfusion (25% vs 18,5%; p= .774) and cardiac activity during arrest (39.6% vs 37.1%; p= 1.0). Values of CK-MB at 24 hours, hs-TnT at 24 hours and hs-TnT at 48 hours were not dependent on age. The CK-MB at 48 hours was dependent on age (p=.039). Probit regression failed to reveal the impact of patients' age on post-clamp VF occurrence ( p=.11) or electrical activity during arrest (p=.57) . CONCLUSIONS Basing on study results, it can be hypothesised that the del Nido cardioplegia provides adequate myocardial protection in AVR patients regardless of age and gender.
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Affiliation(s)
- Krzysztof Sanetra
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kakow University, Krakow, Poland - .,Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland -
| | - Wojciech Domaradzki
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Marek Cisowski
- Department of Cardiac Surgery, Clinical University Hospital, Opole, Poland
| | - Krzysztof Białek
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Rajesh Shrestha
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Andrzej Bochenek
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland.,Faculty of Medicine, University of Technology, Katowice, Poland.,Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | | | - Piotr P Buszman
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kakow University, Krakow, Poland.,Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland.,Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland
| | - Witold Gerber
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
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Reidy MR, Jimenez E, Omer S, Cornwell LD, Runbeck SX, Preventza O, Loor G, Rosengart TK, Coselli JS. Single-Dose del Nido Cardioplegia Compared With Standard Cardioplegia During Coronary Artery Bypass Grafting at a Veterans Affairs Hospital. Tex Heart Inst J 2021; 48:464699. [PMID: 33946111 DOI: 10.14503/thij-19-6981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Del Nido cardioplegic solution (DNC), used chiefly in pediatric patients, rapidly induces prolonged cardiac arrest during cardiac surgery. To determine whether surgical outcomes after coronary artery bypass grafting in a United States military veteran population differed when DNC was used instead of our standard Plegisol cardioplegia, we retrospectively reviewed 155 consecutive operations performed from July 2016 through June 2017. Del Nido cardioplegia was used to induce cardiac arrest in 70 patients, and Plegisol in 85. Compared with the Plegisol group, the DNC group had a shorter mean cardiopulmonary bypass time (96.8 vs 117 min; P <0.01) and aortic cross-clamp time (63.9 vs 71.7 min; P=0.02). On multiple linear regression, DNC use and number of bypasses performed were predictors of cardiopulmonary bypass time. The groups were similar in median number of bypasses performed, median time to extubation, intensive care unit stay, and total postoperative stay; however, the DNC group had a shorter mean operating room time (285.8 vs 364.5 min; P <0.01). Del Nido cardioplegia, number of bypasses, cardiopulmonary bypass time, and red blood cell transfusion were predictors of operating room time. Outcomes in the groups were similar for 30- and 180-day death, stroke, renal failure, ventilation time >48 hours, atrial fibrillation, tracheostomy, reintubation, and mechanical circulatory support. We conclude that single-dose DNC is safe, effective, and cost-effective for achieving cardiac arrest in U.S. veteran populations.
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Affiliation(s)
- Michael R Reidy
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.,Operative Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Ernesto Jimenez
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.,Operative Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Shuab Omer
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.,Operative Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Lorraine D Cornwell
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.,Operative Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Sabrina X Runbeck
- Operative Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.,Cardiovascular Surgery Research, Texas Heart Institute, Houston, Texas
| | - Gabriel Loor
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.,Cardiovascular Surgery Research, Texas Heart Institute, Houston, Texas
| | - Todd K Rosengart
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.,Cardiovascular Surgery Research, Texas Heart Institute, Houston, Texas
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.,Cardiovascular Surgery Research, Texas Heart Institute, Houston, Texas
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10
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Ucak HA, Ucak D. Single-Dose Del Nido Cardioplegia vs. Blood Cardioplegia in Aortic Valve Replacement Surgery. Braz J Cardiovasc Surg 2021; 36:229-236. [PMID: 33113318 PMCID: PMC8163264 DOI: 10.21470/1678-9741-2020-0063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In this study, we aimed to compare Del Nido cardioplegia (DNC) with blood cardioplegia (BC) in aortic valve replacement. METHODS A two-year single-institute retrospective cohort study was accomplished. Subjects who underwent aortic valve replacement surgery were divided into two groups (DNC and BC) and outcomes were compared. RESULTS Preoperative demographics and clinical data of the patients in both groups were similar. The time until cardiac arrest following administration of the first dose of cardioplegia was statistically significantly shorter in the BC group (47.0 sec. 25-103) than in the DNC group (63.0 sec. 48-140) (P=0.012). Cross-clamping time was longer in the BC group (48.7±12.3 min. vs. 41.5±11.8 min.) (P=0.041). Cardiopulmonary bypass time was statistically significantly shorter in the DNC group (BC 60.8±18.5 min., DNC 53.7±15.2 min.) (P=0.046). The rate of postoperative use of intravenous positive inotropic support drugs (dopamine, dobutamine, norepinephrine, etc.) for more than two hours was significantly higher in the BC group (20 [23.5%] in the BC group and nine [17.3%] in the DNC group) (P=0.035). Creatine kinase myocardial band and troponin I levels were slightly lower in patients receiving DNC, but no statistically significant difference was detected. CONCLUSION Del Nido cardioplegia is safe and can be used efficiently as an alternative to blood cardioplegia in isolated aortic valve replacement surgery.
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Affiliation(s)
- Haci Ali Ucak
- Department of Cardiovascular Surgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Dilek Ucak
- Department of Anesthesiology and Reanimation, Adana City Training and Research Hospital, Adana, Turkey
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Sanrı US, Özsin KK, Toktaş F, Yavuz Ş. Comparison of Del Nido Cardioplegia and Blood Cardioplegia in Terms of Development of Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2021; 36:158-164. [PMID: 34048202 PMCID: PMC8163282 DOI: 10.21470/1678-9741-2020-0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Del Nido cardioplegia (DNC) has been used in pediatric cardiac surgery for many years with a single dose application and its usage in adult cardiac surgery has been increasing in recent years, with results being published. In this study, we aimed to investigate the effect of DNC on the development of postoperative atrial fibrillation (PoAF). Methods In this retrospective observational comparative study, 255 patients who underwent isolated on-pump coronary artery bypass grafting, between January 2019 and November 2019, were enrolled. The patients were divided into two groups: DNC (n=132) and blood cardioplegia (BC) (n=123). Intraoperative and postoperative data were evaluated and compared in terms of the development of PoAF. Results We found that the development of PoAF and the length of hospital stay remain significantly higher in the BC group (P=0.044, P<0.001, respectively). In addition, the aortic cross-clamp time and the cardioplegia volume delivered were significantly lower in the DNC group (P=0.042, P<0.001, respectively). In multivariate logistic regression analysis, only higher cardioplegia volume was determined as an independent predictor for PoAF development (OR 1.001; 95% CI 1.000-1.001; P=0.033). We did not found difference between groups in terms of troponin T, inotropic drug support, need for intraaortic balloon pump and mortality. Conclusion This study showed that DNC can be used safely in adult coronary bypass surgery and PoAF development effect is reduced.
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Affiliation(s)
- Umut Serhat Sanrı
- Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Kadir Kaan Özsin
- Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Faruk Toktaş
- Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Şenol Yavuz
- Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Lee CH, Kwon Y, Park SJ, Lee JW, Kim JB. Comparison of del Nido and histidine-tryptophan-ketoglutarate cardioplegic solutions in minimally invasive cardiac surgery. J Thorac Cardiovasc Surg 2020; 164:e161-e171. [PMID: 33487412 DOI: 10.1016/j.jtcvs.2020.11.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We examined the safety and efficacy of del Nido cardioplegic solution compared with histidine-tryptophan-ketoglutarate cardioplegic solution in minimally invasive cardiac surgery. METHODS Patients who underwent minimally invasive cardiac surgery using del Nido or histidine-tryptophan-ketoglutarate from 2015 to 2019 were enrolled. Various clinical outcomes were compared between the groups. Postoperative laboratory findings including the levels of electrolytes, cardiac enzymes (creatine kinase-MB and troponin I), and serial blood lactate were also measured and compared. Based on 28 baseline covariates, propensity score matching was performed to reduce selection bias. RESULTS Among 766 patients, del Nido and histidine-tryptophan-ketoglutarate were used in 330 patients (43.1%) and 436 patients (56.9%), respectively. There were no significant intergroup differences in postoperative clinical outcomes and early adverse outcomes among 228 pairs of propensity score-matched patients. Immediate postoperative sodium levels were within the normal range in both groups without a significant difference (P = .50). However, peak creatine kinase-MB (median, 31.9 vs 37.7 ng/mL, P = .026) and troponin I (6.9 vs 9.1 ng/mL, P = .014) levels were significantly lower in the del Nido group. Linear regression analysis revealed a significant association between the peak cardiac enzyme levels and the cardiac ischemic time depending on the cardioplegia type, with lower cardiac isoenzymes for del Nido over histidine-tryptophan-ketoglutarate (P < .001) until the crossover point at the cardiac ischemic time over 100 minutes. CONCLUSIONS In comparison with histidine-tryptophan-ketoglutarate solution, del Nido solution seems to have acceptable safety and efficacy with good myocardial protection in minimally invasive cardiac surgery. Further studies focusing on complex surgeries requiring longer cardiac ischemic time are needed.
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Affiliation(s)
- Chee-Hoon Lee
- Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Seoul, South Korea
| | - Youngkern Kwon
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Sung Jun Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
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Sharma A, Dixit S, Mittal S, Sharma M, Sharma D, Mawar KK. DelNido cardioplegia versus St Thomas cardioplegia solution in double valve replacement: a single centre experience. Perfusion 2020; 36:476-481. [PMID: 33203307 DOI: 10.1177/0267659120961921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The role of cardioplegia cannot be underrated in cardiac surgery. St Thomas solution is the most widely used cardioplegic, but needs repeated dosing. Del Nido solution provides long duration of asystole with adequate protection; but has been used mainly in paediatric patients. This study was aimed to compare Del Nido cardioplegia with St Thomas cardioplegia in adult cardiac surgeries, requiring double valve replacement and compare the outcomes. METHODOLOGY This retrospective, observational, descriptive study was conducted over a time period spanning from January 2016 to December 2019. A total of 209 patients were included and were separated in two groups DC group (n = 114) and BC group (n = 95) on the basis of cardioplegic solution used. Del Nido solution was administered as single dose. Parameters noted were CPB time, cross clamp time, wean off bypass time, DC shocks given, inotropic support required, ventilation duration, duration of ICU and hospital stay. RESULTS There was significantly shorter aortic cross clamp time (72.6 ± 10.2 vs. 98.2 ± 9.2), CPB time (92.1 ± 12.3 vs.129.5 ± 11) and wean off bypass time (19.4 ± 5.9 vs. 31.3 ± 7.6) and less requirement of DC shocks (21.2% vs. 65.9%) in DC group. Inotropic requirement in immediate post-operative period was significantly less in DC group both on day of surgery (5.35 ± 1.44 vs. 7.52 ± 3.8) and 24 hours later (3.4 ± 2.12 vs. 2.18 ± 0.72). There was no significant difference in duration of ventilation, ICU and hospital stay. CONCLUSION Del Nido can be used safely in long duration adult cardiac surgeries and in a single dose with better intra operative and immediate post-operative outcomes as compared to St Thomas solution.
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Affiliation(s)
- Anil Sharma
- Department of Cardiothoracic and Vascular Surgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Sunil Dixit
- Department of Cardiothoracic and Vascular Surgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Sourabh Mittal
- Department of Cardiothoracic and Vascular Surgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Mohit Sharma
- Department of Cardiothoracic and Vascular Surgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Dhruva Sharma
- Department of Cardiothoracic and Vascular Surgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - K K Mawar
- Department of Cardiothoracic and Vascular Surgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
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An acute estrogen receptor agonist enhances protective effects of cardioplegia in hearts from aging male and female mice. Exp Gerontol 2020; 141:111093. [DOI: 10.1016/j.exger.2020.111093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 01/01/2023]
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15
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Algarni KD. Routine use of del Nido cardioplegia compared with blood cardioplegia in all types of adult cardiac surgery procedures. J Card Surg 2020; 35:3340-3346. [DOI: 10.1111/jocs.15060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/04/2020] [Accepted: 09/12/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Khaled D. Algarni
- Department of Cardiac Sciences, College of Medicine King Saud University Riyadh Saudi Arabia
- Department of Adult Cardiac Surgery Prince Sultan Cardiac Center Riyadh Saudi Arabia
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Orak Y, Kocarslan A, Boran OF, Acıpayam M, Eroglu E, Kirisci M, Doganer A. Comparison of the operative and postoperative effects of del Nido and blood cardioplegia solutions in cardiopulmonary bypass surgery. Braz J Cardiovasc Surg 2020; 35:689-696. [PMID: 33118734 PMCID: PMC7598972 DOI: 10.21470/1678-9741-2019-0436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Our goal was to compare the operative and postoperative effects of del Nido cardioplegia (DN group) and blood cardioplegia (BC group) performed in cardiac surgery. METHODS A total of 83 patients were included, separated into DN group and BC group. The operative and postoperative effects of the two groups were compared for the first 24 hours until extubation. The operative and postoperative complete blood count (CBC), biochemical values and clinical parameters were compared. RESULTS The first control activated clotting time (ACT) levels in DN group patients were lower (P=0.003) during the operation. The amount of cardioplegia in DN group were lower than that in BC group (P=0.001). The pump outflow and postoperative lactate level of DN group were lower than those of BC group (P=0.005, P=0.018, respectively), as well as the amounts of NaHCO3 (P=0.006) and KCl (P=0.001) used during the operation. The same occurred with the first monocytes (Mo) and mean corpuscular volume (MCV) levels in the postoperative intensive care unit (P=0.006, P=0.002). However, the first glucose level and the eosinophil (Eo) level were higher in DN group (P=0.011, P=0.047, respectively). CONCLUSION In the operative evaluation, the amount of cardioplegia, the first ACT levels, the pump outflow lactate level and the amounts of NaHCO3 and KCl in DN group were lower. In postoperative evaluation, measured level of lactate, Mo and MCV in DN group were all lower; their glucose and Eo levels were higher.
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Affiliation(s)
- Yavuz Orak
- Kahramanmaras Sutcu Imam University Faculty of Medicine Department of Anesthesiology and Reanimation Kahramanmaras Turkey Department of Anesthesiology and Reanimation, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Aydemir Kocarslan
- Kahramanmaras Sutcu Imam University Faculty of Medicine Department of Cardiovascular Surgery Kahramanmaraş Turkey Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaraş, Turkey
| | - Omer Faruk Boran
- Kahramanmaras Sutcu Imam University Faculty of Medicine Department of Anesthesiology and Reanimation Kahramanmaras Turkey Department of Anesthesiology and Reanimation, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Mehmet Acıpayam
- Kahramanmaras Sutcu Imam University Faculty of Medicine Department of Cardiovascular Surgery Kahramanmaraş Turkey Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaraş, Turkey
| | - Erdinc Eroglu
- Kahramanmaras Sutcu Imam University Faculty of Medicine Department of Cardiovascular Surgery Kahramanmaraş Turkey Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaraş, Turkey
| | - Mehmet Kirisci
- Kahramanmaras Sutcu Imam University Faculty of Medicine Department of Cardiovascular Surgery Kahramanmaraş Turkey Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaraş, Turkey
| | - Adem Doganer
- Kahramanmaras Sutcu Imam University Faculty of Medicine Department of Biostatistics and Medical Informatics Kahramanmaraş Turkey Department of Biostatistics and Medical Informatics, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaraş, Turkey
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Shi H, Luo H, Qi X, Zhao H, Liu C, Chen H, Peng R, Yu Z, Hu K, Li X, Wang C. del Nido cardioplegia in surgery for aortic root disease: a historically controlled study. J Thorac Dis 2020; 12:4105-4114. [PMID: 32944322 PMCID: PMC7475601 DOI: 10.21037/jtd-20-1101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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 vs. 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% vs. 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 vs. 0.49 ng/mL for DNC group, P=0.152), left ventricular ejection fraction (mean 58.37% for CBC group vs. 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 vs. 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.
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Affiliation(s)
- Hui Shi
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Haiyan Luo
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaomin Qi
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Zhao
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chaoqi Liu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hongsong Chen
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Runsheng Peng
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhangsheng Yu
- Department of Bioinformatics and Biostatistics, SJTU-Yale Joint Center for Biostatistics, Jiao Tong University, Shanghai, China
| | - Kejian Hu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Li
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Garcia-Suarez J, Garcia Fernandez J, Sanz S, Martinez Lopez D, Reques L, Forteza Gil A. Del Nido Cardioplegia Versus Cold Blood Cardioplegia in Adult Cardiac Surgery: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e17826. [PMID: 32673265 PMCID: PMC7388037 DOI: 10.2196/17826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background The use of cardioplegia solutions as a myocardial protection technique is essential during cardiac surgery with cardiopulmonary bypass. The del Nido cardioplegia solution (DNS) has been widely used as a myocardial preservation technique for pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Its unique pharmacological features have created growing interest for adult cardiac surgery, especially for elderly patients or those with ventricular dysfunction who are more prone to ischemia-reperfusion injury. Ever since its implementation, several retrospective studies have been published to validate the efficacy, safety, and efficiency of DNS in adult patients undergoing coronary revascularization, valve replacement, or combined procedures. Recently, a meta-analysis based on nine retrospective studies was published claiming the noninferiority of DNS compared to other conventional cardioplegia solutions. Few prospective randomized studies have been conducted whose primary outcome was the assessment of DNS clinical efficacy compared to other solutions commonly used in adult patients. Objective The aim of this randomized clinical trial is to assess the benefits of DNS compared to Cardi-Braun blood cardioplegia solution in clinical and biochemical terms regarding myocardial protection during adult cardiac surgery. Methods This is the protocol of a controlled, randomized, single-center clinical trial carried out at the Puerta de Hierro Majadahonda University Hospital in Spain. A total of 474 participants over the age of 18 years undergoing elective cardiac surgery with cardiopulmonary bypass will be assigned to groups by simple randomization to receive either DNS or Cardi-Braun blood cardioplegia solution. The primary outcome will be the differences between groups in myocardial protection in biochemical terms (ie, perioperative troponin levels) and clinical terms (ie, presence of the composite variable acute cardiovascular event). The clinical trial will be carried out under conditions of respect for the fundamental rights of the person and the ethical principles that affect biomedical research with human beings, as well as in accordance with international recommendations contained in the Declaration of Helsinki and its subsequent revisions. Results The inclusion process started in 2018. Data cleaning and analyses are expected to take place in the fall of 2020 and the results are expected in January 2021. Conclusions This study is particularly relevant as it will be one of the first to analyze the clinical effects of del Nido cardioplegia on the basis of direct myocardial protection parameters. In light of published studies, carrying out prospective studies based on primary clinical objectives with a larger sample, high-risk patients, and longer cardiopulmonary bypass times continues to be necessary. We believe that our study addresses an important gap in the knowledge of del Nido cardioplegia in adult patient cardiac surgery and will be able to clarify the possible benefits of this method in a large population of patients undergoing these procedures. Trial Registration European Union Drug Regulating Authorities Clinical Trials Database (EudraCT) 2017-005144-14; https://www.clinicaltrialsregister.eu/ctr-search/search?query=2017-005144-14+; ClinicalTrials.gov NCT04094168; https://clinicaltrials.gov/ct2/show/NCT04094168 International Registered Report Identifier (IRRID) DERR1-10.2196/17826
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Affiliation(s)
- Jessica Garcia-Suarez
- Department of Anesthesiology and Critical Care, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Javier Garcia Fernandez
- Department of Anesthesiology and Critical Care, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Sergio Sanz
- Department of Anesthesiology and Critical Care, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Daniel Martinez Lopez
- Department of Cardiovascular Surgery, Puerta de Hierro Majadahonda University Hospital, Majadahonda, Madrid, Spain
| | - Leticia Reques
- Department of Cardiovascular Surgery, Puerta de Hierro Majadahonda University Hospital, Majadahonda, Madrid, Spain
| | - Alberto Forteza Gil
- Department of Cardiovascular Surgery, Puerta de Hierro Majadahonda University Hospital, Majadahonda, Madrid, Spain
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Bigdelian H, Hosseini A. Effect of single-dose crystalloid cardioplegic agent compared to bloody cardioplegic agent in cardiac surgery in children with Tetralogy of Fallot. ARYA ATHEROSCLEROSIS 2020; 16:24-32. [PMID: 32499828 PMCID: PMC7244793 DOI: 10.22122/arya.v16i1.1943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cardioplegia is one of the main post-operative cardiac protective factors widely used in recent decades in the form of crystalloid (St. Thomas) and bloody solutions [del Nido (DN)]. The purpose of this study was to compare the effect of a crystalloid cardioplegic agent (St. Thomas) with that of a bloody cardioplegic agent (DN) in pediatric cardiac surgery among children with Tetralogy of Fallot (TOF). METHODS This study was performed on 60 children with TOF, who were candidates for heart repair surgery. The participants were randomly divided into two groups of crystalloid cardioplegic agent and bloody cardioplegic agent. Operative outcomes such as required time for onset of heart arrest, duration of returning to normal heart rhythm, and cardiopulmonary bypass (CPB) time, and operative complications were compared between the two groups. RESULTS The duration of returning to normal heart rhythm (50.43 ± 10.93 seconds vs. 43.03 ± 16.35 seconds; P = 0.044) and duration of inotropy (80.40 ± 27.14 hours vs. 63.20 ± 26.91 hours; P = 0.017) were significantly higher in the DN group compared to the St. Thomas group. However, there were no significant differences between the two groups in terms of heart arrest time, cross-clamp time, CPB time, supplementary lasix time, duration of intubation, and intensive care unit (ICU) and hospital length of stay (LOS) (P > 0.050). CONCLUSION The use of St. Thomas cardioplegic solution was more effective in reducing the duration of returning to normal heart rhythm and inotropy compared with DN cardioplegic agent, and a single dose of these two cardioplegic agents can keep the mean cardiac arrest duration within the range of 50-70 minutes. It seems that the use of St. Thomas cardioplegic solution can be suggested in pediatric heart surgery.
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Affiliation(s)
- Hamid Bigdelian
- Associate Professor, Department of Cardiac Surgery, School of Medicine AND Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Hosseini
- Assistant Professor, Department of Cardiac Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Marzouk M, Lafreniere-Bessi V, Dionne S, Simard S, Pigeon C, Dagenais F, Ad N, Jacques F. Transitioning to Del Nido cardioplegia for all-comers: the next switching gear? BMC Cardiovasc Disord 2020; 20:215. [PMID: 32384925 PMCID: PMC7206735 DOI: 10.1186/s12872-020-01506-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background Exclusive use of Del Nido cardioplegia administration in all adult patients undergoing cardiac surgery has been studied for operative, postoperative and myocardial protection outcomes. Methods From November 2016 to October 2017, Del Nido cardioplegia was used in 131 consecutive patients (DN group). Using a propensity score, DN group was compared to 251 patients having received intermittent cold blood cardioplegia (CB group). Results Preoperative characteristics were similar in DN and CB groups. Operative outcomes were statistically different (p < 0.0001): cardiopulmonary bypass (CPB) time (DN 105.9 ± 46.5, CB 131.2 ± 38.8); aortic cross-clamp time (DN 80.8 ± 35.5, CB 102.2 ± 31.3); operative time (DN 203.1 ± 65.0, CB 241.5 ± 54.7); total cardioplegia volume (DN 1328 ± 879, CB 3773 ± 1226); and peak glycemia on CPB (DN 8.2 ± 2.3, CB 9.0 ± 1.8). No statistical differences were noted in intensive care unit stay, hospital stay and hospital death. Myocardial protection outcomes were similar: discharge left ventricular ejection fraction (DN 52 ± 11, CB 51 ± 10); Troponin levels at the end of the surgery (DN 871 ± 1623, CB 1958 ± 854), day 1 (DN 853 ± 1139, CB 993 ± 8234) and day 4 (DN 442 ± 540, CB 463 ± 317). Conclusion Del Nido cardioplegia use in all adult cardiac surgeries is associated with improved surgical efficiency. The design of larger trials including adults combined cardiac procedures and emergencies is needed.
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Affiliation(s)
- Mohamed Marzouk
- Service of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec-IUCPQ, Université Laval, Quebec City, QC, G1V 4G5, Canada
| | - Valerie Lafreniere-Bessi
- Service of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec-IUCPQ, Université Laval, Quebec City, QC, G1V 4G5, Canada
| | - Stephanie Dionne
- Service of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec-IUCPQ, Université Laval, Quebec City, QC, G1V 4G5, Canada
| | - Serge Simard
- Biostatistics, Institut universitaire de cardiologie et de pneumologie de Québec-IUCPQ, Université Laval, Québec, QC, Canada
| | - Christian Pigeon
- Service of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec-IUCPQ, Université Laval, Quebec City, QC, G1V 4G5, Canada
| | - François Dagenais
- Service of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec-IUCPQ, Université Laval, Quebec City, QC, G1V 4G5, Canada
| | - Niv Ad
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Frederic Jacques
- Service of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec-IUCPQ, Université Laval, Quebec City, QC, G1V 4G5, Canada.
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Loberman D, Pelletier MP, Yazdchi F, Aranki SF, Preisler Y, Mohr R, Ziv‐Baran T. Myocardial preservation methods in isolated minimal invasive mitral valve surgery: Society of Thoracic Surgeons (STS) database outcomes. J Card Surg 2019; 35:163-173. [DOI: 10.1111/jocs.14351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dan Loberman
- Division of Cardiac Surgery, Brigham and Women’s Hospital Harvard Medical School Boston Massachusetts USA
- Cardiovascular Center Cape Cod Hospital Hyannis Massachusetts USA
| | - Marc P. Pelletier
- Division of Cardiac Surgery, Brigham and Women’s Hospital Harvard Medical School Boston Massachusetts USA
- Cardiovascular Center Cape Cod Hospital Hyannis Massachusetts USA
| | - Farchang Yazdchi
- Division of Cardiac Surgery, Brigham and Women’s Hospital Harvard Medical School Boston Massachusetts USA
- Cardiovascular Center Cape Cod Hospital Hyannis Massachusetts USA
| | - Sary F. Aranki
- Division of Cardiac Surgery, Brigham and Women’s Hospital Harvard Medical School Boston Massachusetts USA
- Cardiovascular Center Cape Cod Hospital Hyannis Massachusetts USA
| | - Yoav Preisler
- School of Medicine, Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Rephael Mohr
- School of Medicine, Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Tomer Ziv‐Baran
- School of Public Health, Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Commentary: del Nido cardioplegia: Can we and do we need to prove the benefit? J Thorac Cardiovasc Surg 2019; 159:2284-2285. [PMID: 31324425 DOI: 10.1016/j.jtcvs.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 11/22/2022]
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Spellman J. Pro: In Favor of More Generalized Use of del Nido Cardioplegia in Adult Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2018.01.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kim WK, Kim HR, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. del Nido cardioplegia in adult cardiac surgery: beyond single-valve surgery. Interact Cardiovasc Thorac Surg 2019; 27:81-87. [PMID: 29452357 DOI: 10.1093/icvts/ivy028] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/22/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In recent years, the use of del Nido (DN) cardioplegia has been reported in single-valve surgery or isolated coronary artery bypass surgery with acceptable outcomes. The reports of its use in more complex adult cardiac procedures, however, have been scarce. METHODS We enrolled a total of 149 adult patients who underwent heart valve surgery with the use of DN cardioplegia between May 2014 and December 2016. For a benchmark comparison, 892 patients who underwent cardiac valve surgery with blood cardioplegia during the same period served as controls. To reduce selection bias, propensity score matching was used; the inverse probability of treatment weighting method was performed for further validations. RESULTS Overall, 57.7% of patients in the DN group underwent multiple or complex cardiac procedures. Early mortality rates were 0.7% and 2.4% in the DN and blood groups, respectively (P = 0.31). Propensity score matching yielded 111 pairs of patients who were well balanced for all 23 measured baseline covariates. In the matched cohort, the postoperative peak troponin I levels (P = 0.004) and the aortic clamping times (P < 0.001) were significantly lower and shorter compared with those in the blood group. There were no significant differences in early mortality rates (1.9% vs 0%, P > 0.99), low cardiac output (P = 0.57) and neurological events (P = 0.21). The quantities of postoperative transfusions (P = 0.008) and fluid supplements (P < 0.001) were significantly lower in the matched DN group compared with the blood group. CONCLUSIONS The use of DN in adult valve surgery including complex procedures may confer acceptable outcomes comparable to or even superior to those obtained with the use of blood cardioplegia.
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Affiliation(s)
- Wan Kee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hong Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Stamou SC, Lopez C, Novello C, Nores MA. Modified whole blood microplegia in high-risk patients. J Card Surg 2019; 34:118-123. [PMID: 30761609 DOI: 10.1111/jocs.13993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Numerous studies have documented the safety of whole blood cardioplegia on clinical outcomes after cardiac surgery. However, there is a paucity of studies investigating the outcomes of whole blood microplegia after cardiac surgery. Our protocol of whole blood microplegia includes removal of the crystalloid portion and utilizing the Quest Myocardial Protection System, for delivery of del Nido cardioplegia additives in whole blood. This study sought to evaluate the effects of whole blood microplegia on clinical outcomes, following cardiac surgery, in high-risk cardiac surgery patients. METHODS Between February 2016 and December 2017, 131 high-risk patients underwent cardiac surgery operations, utilizing whole blood microplegia and were compared with a contemporaneous control group of 236 low-risk patients. High-risk patients included those who underwent combined coronary artery bypass grafting (CABG) and valve repair or replacement, double-valve surgery, triple-valve repair or replacement, and patients with ejection fraction < 40%. Multivariable logistic regression analysis was performed to identify independent risk factors of mortality after cardiac surgery. RESULTS Operative mortality was 7% for high-risk and 0% for low-risk patients (P < 0.001). Of those patients, five had isolated CABG (two had emergent CABG), two had double-valve surgery, two had combined valve/CABG. In multivariate analysis, high-risk classification (odds ratio = 3.66, 95% confidence intervals = 1.04-12.9, P = 0.04), emerged as an independent predictor of operative mortality. CONCLUSIONS Whole blood microplegia, is a novel myocardial protection strategy that can be applied in high-risk cardiac surgery patients and prolonged operations, requiring cardioplegic arrest with acceptable early clinical outcomes.
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Affiliation(s)
- Sotiris C Stamou
- Department of Thoracic and Cardiovascular Surgery, JFK Medical Center, Atlantis, Florida
| | - Cassandra Lopez
- Department of Thoracic and Cardiovascular Surgery, JFK Medical Center, Atlantis, Florida
| | - Courtney Novello
- Department of Thoracic and Cardiovascular Surgery, JFK Medical Center, Atlantis, Florida
| | - Marcos A Nores
- Department of Thoracic and Cardiovascular Surgery, JFK Medical Center, Atlantis, Florida
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Cayir MC, Yuksel A. The Use of del Nido Cardioplegia for Myocardial Protection in Isolated Coronary Artery Bypass Surgery. Heart Lung Circ 2019; 29:301-307. [PMID: 30723044 DOI: 10.1016/j.hlc.2018.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/11/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The del Nido (DN) cardioplegia solution has been widely used in paediatric open-heart surgery for years; however, its application in adult open-heart surgery has not yet gained sufficient popularity. We investigated the safety and efficiency of the DN cardioplegia solution versus the traditional crystalloid cardioplegia solution [St. Thomas' Hospital (STH) cardioplegia solution] in adult patients undergoing coronary artery bypass grafting (CABG). METHODS A retrospective comparative analysis of 200 consecutive patients undergoing isolated on-pump CABG between April 2016 and September 2017 was performed. Patients were divided into two groups: DN group (n = 100) and STH group (n = 100). Groups were compared with regard to perioperative clinical outcomes, and the safety and efficiency of the DN cardioplegia solution in CABG surgery were evaluated. RESULTS In the DN group, mean aortic cross-clamp, cardiopulmonary bypass, and total operation times were significantly shorter than in the STH group. After the release of the aortic cross-clamp, the requirement for intraoperative defibrillation was significantly less in the DN group. There were no significant differences between the groups in terms of the levels of perioperative cardiac biomarkers (including creatine kinase-myocardial band and troponin I), major postoperative adverse events, and in-hospital mortality. CONCLUSIONS This study revealed that the use of the DN cardioplegia solution in adult patients undergoing isolated CABG provides significantly shorter aortic cross-clamp, cardiopulmonary bypass, and total operation times compared with the traditional cardioplegias solution. The DN solution could be used as a safe and efficient alternative to the traditional cardioplegia solutions in CABG surgery.
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Affiliation(s)
- Mustafa Cagdas Cayir
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ahmet Yuksel
- Department of Cardiovascular Surgery, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey.
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Carmo HPD, Reichert K, Carvalho DDD, Silveira-Filho LDM, Vilarinho K, Oliveira P, Petrucci O. Lidocaine and Pinacidil Added to Blood versus Crystalloid Cardioplegic Solutions: Study in Isolated Hearts. Braz J Cardiovasc Surg 2019; 33:211-216. [PMID: 30043912 PMCID: PMC6089128 DOI: 10.21470/1678-9741-2017-0244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The present study aimed the functional recovery evaluation after long term of cardiac arrest induced by Custodiol (crystalloid-based) versus del Nido (blood-based) solutions, both added lidocaine and pinacidil as cardioplegic agents. Experiments were performed in isolated rat heart perfusion models. METHODS Male rat heart perfusions, according to Langendorff technique, were induced to cause 3 hours of cardiac arrest with a single dose. The hearts were assigned to one of the following three groups: (I) control; (II) Custodiol-LP; and (III) del Nido-LP. They were evaluated after ischemia throughout 90 minutes of reperfusion. Left ventricular contractility function was reported as percentage of recovery, expressed by developed pressure, maximum dP/dt, minimum dP/dt, and rate pressure product variables. In addition, coronary resistance and myocardial injury marker by alpha-fodrin degradation were also evaluated. RESULTS At 90 minutes of reperfusion, both solutions had superior left ventricular contractile recovery function than the control group. Del Nido-LP was superior to Custodiol-LP in maximum dP/dt (46%±8 vs. 67%±7, P<0.05) and minimum dP/dt (31%±4 vs. 51%±9, P<0.05) variables. Coronary resistance was lower in del Nido-LP group than in Custodiol-LP (395%±50 vs. 307%±13, P<0.05), as well as alpha-fodrin degradation, with lower levels in del Nido-LP group (P<0.05). CONCLUSION Del Nido-LP cardioplegia showed higher functional recovery after 3 hours of ischemia. The analysis of alpha-fodrin degradation showed del Nido-LP solution provided greater protection against myocardial ischemia and reperfusion (IR) in this experimental model.
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Affiliation(s)
| | - Karla Reichert
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | | | | | - Karlos Vilarinho
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Pedro Oliveira
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Orlando Petrucci
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
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O'Donnell C, Wang H, Tran P, Miller S, Shuttleworth P, Boyd JH. Utilization of Del Nido Cardioplegia in Adult Coronary Artery Bypass Grafting - A Retrospective Analysis. Circ J 2018; 83:342-346. [PMID: 30531128 DOI: 10.1253/circj.cj-18-0780] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Studies assessing the safety and effectiveness of Del Nido cardioplegia for adult cardiac surgery remain limited. We investigated early outcomes after coronary artery bypass grafting (CABG) using single-dose Del Nido cardioplegia vs. conventional multi-dose blood cardioplegia. Methods and Results: The 81 consecutive patients underwent isolated CABG performed by a single surgeon. The initial 27 patients received anterograde blood cardioplegia, while the subsequent 54 patients received anterograde Del Nido cardioplegia. There were no differences in the baseline characteristics of each group nor any differences in the 30-day incidences of myocardial infarction, all-cause death, and readmission following surgery. The use of Del Nido cardioplegia was associated with shorter cardiopulmonary bypass time (98 vs. 115 min, P=0.011), shorter cross-clamp time (74 vs. 87 min, P=0.006), and decreased need for intraoperative defibrillation (13.0% vs. 33.3%, P=0.030) compared with blood cardioplegia. To control for the difference in cross-clamp time, we performed propensity score matching with a logistical treatment model and confirmed that Del Nido cardioplegia provided similar outcomes as blood cardioplegia and also reduced the need for defibrillation independent of cross-clamp time. CONCLUSIONS Compared with conventional blood cardioplegia, Del Nido cardioplegia provided excellent myocardial protection with reduced need for intraoperative defibrillation, shorter bypass and cross-clamp times, and comparable early clinical outcomes for adult patients undergoing CABG.
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Affiliation(s)
- Christian O'Donnell
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Phat Tran
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Shari Miller
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Paul Shuttleworth
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Jack H Boyd
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
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Ucak HA, Uncu H. Comparison of Del Nido and Intermittent Warm Blood Cardioplegia in Coronary Artery Bypass Grafting Surgery. Ann Thorac Cardiovasc Surg 2018; 25:39-45. [PMID: 30089762 PMCID: PMC6388299 DOI: 10.5761/atcs.oa.18-00087] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose: In this study, we aim to investigate the efficacy and clinical results of using Del Nido solution (DNS) in coronary artery bypass grafting (CABG) surgery by comparing with intermittent warm blood cardioplegia (IWBC). Methods: Between March 2017 and February 2018, 297 adult patients who underwent primary isolated CABG surgery with cardiopulmonary bypass (CPB) were included in the study. We used DNS in 112 patients and IWBC was used in 185 patients. We compared both the clinical and the laboratory results. Results: Aortic cross-clamp time, CPB time, and peak glucose level are lower with DNS. But we did not observe any meaningful difference of clinical results between two methods including postoperative myocardial enzyme release. Conclusion: Del Nido cardioplegia was developed for immature heart and pediatric surgery. But in our opinion, it is a good and useful alternative to CABG surgery with similar results to IWBC.
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Affiliation(s)
- Haci Ali Ucak
- Department of Cardiovascular Surgery, University of Health Sciences Adana City Hospital, Adana, Turkey
| | - Hasan Uncu
- Department of Cardiovascular Surgery, University of Health Sciences Adana City Hospital, Adana, Turkey
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Heydarpour M, Ejiofor J, Gilfeather M, Stone G, Gorham J, Seidman CE, Seidman JG, Yammine M, Body SC, Aranki SF, Muehlschlegel JD. Molecular Genetics of Lidocaine-Containing Cardioplegia in the Human Heart During Cardiac Surgery. Ann Thorac Surg 2018; 106:1379-1387. [PMID: 30028983 DOI: 10.1016/j.athoracsur.2018.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND During cardiac surgery with cardiopulmonary bypass, delivery of cardioplegia solution to achieve electromechanical cardiac quiescence is obligatory. The addition of lidocaine to cardioplegia has advantages, although its consequences at a molecular level remain unclear. We performed whole-genome RNA sequencing of the human left ventricular (LV) myocardium to elucidate the differences between whole-blood (WB) cardioplegia with and without addition of lidocaine (LC) on gene expression. METHODS We prospectively enrolled 130 patients undergoing aortic valve replacement surgery. Patients received high-potassium blood cardioplegia either with (n = 37) or without (n = 93) lidocaine. The LV apex was biopsied at baseline, and after an average of 74 minutes of cold cardioplegic arrest. We performed differential gene expression analysis for 18,258 genes between these 2 groups. Clinical and demographic variables were adjusted in the model. Gene ontology (GO) and network enrichment analysis of the retained genes were performed using g:Profiler and Cytoscape. RESULTS A total of 1,298 genes were differentially expressed between cardioplegic treatments. Compared with the WB group, genes upregulated in the LC group were identified by network enrichment to play a protective role in ischemic injury by inhibiting apoptosis, increasing transferrin endocytosis, and increasing cell viability. Downregulated genes in the LC group were identified to play a role in inflammatory diseases, oxygen transport, and neutrophil aggregation. CONCLUSIONS The addition of lidocaine to cardioplegia had pronounced effects on a molecular level with genes responsible for decreased inflammation, reduced intracellular calcium binding, enhanced antiapoptotic protection, augmented oxygen accessibility through transferrins, and increased cell viability showing measurable differences.
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Affiliation(s)
- Mahyar Heydarpour
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julius Ejiofor
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Gilfeather
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory Stone
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Josh Gorham
- Department of Genetics, Harvard Medical School, Boston, Massachusetts
| | - Christine E Seidman
- Howard Hughes Medical Institute, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jon G Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts
| | - Maroun Yammine
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Simon C Body
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sary F Aranki
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Comparison of del Nido Cardioplegia With Blood Cardioplegia in Adult Combined Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 12:356-362. [PMID: 29016380 DOI: 10.1097/imi.0000000000000403] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE del Nido solution (DNS) is a single-dose cardioplegia designed for pediatric use proposed to offer superior myocardial protection in adults. However, few data support this claim. We hypothesized that DNS and modified blood cardioplegia solution (BS) provide equivalent safety in combined adult valve surgery. METHODS Between November 2014 and December 2015, 25 patients underwent primary aortic valve replacement and concomitant coronary artery bypass grafting (CABG) with DNS. Outcomes were compared with 25 patients who underwent the same surgery with BS between September 2013 and August 2015. RESULTS All preoperative characteristics, comorbidities, and number of CABG performed were similar between groups. One hospital death occurred in the BS group. Postoperative creatine kinase, MB isotype (16.7 ± 5.3 μg/L vs. 22.1 ± 8.9 μg/L, P = 0.011) and troponin T levels (260 ± 105.3 ng/L vs. 370.5 ± 218.4 ng/L, P = 0.028) were significantly lower in the DNS group. There was no difference in inotropic or vasoactive agent use (P = 0.512). Cardiopulmonary bypass times (65.5 ± 12.5 min vs. 76.6 ± 19.1 min, P = 0.019) and cross-clamp times (55.6 ± 11.2 min vs. 64.3 ± 18.9 min, P = 0.05) were lower in the DNS group but total operating room times (P = 0.198) were similar. Peak postoperative creatinine levels were similar in both groups (P = 0.063). There was no difference in postoperative outcomes including acute renal failure (P > 0.999), atrial fibrillation (P = 0.773), acute respiratory failure (P > 0.999), nor stroke or transient ischemic attack (P > 0.999). Intensive care unit stay (P = 0.213) and hospital stay (P = 0.1) did not differ between groups. CONCLUSIONS The DNS can be used as an alternative to BS in adult concomitant aortic valve replacement + CABG surgery. This supports our hypothesis that in this specific setting, DNS provides comparable myocardial protection as BS, with possibly shorter cardiopulmonary bypass and cross-clamp times.
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Jiang X, Gu T, Shi E, Wang C, Xiu Z, Zhang G. Antegrade Versus Continuous Retrograde del Nido Cardioplegia in the David I Operation. Heart Lung Circ 2018; 27:497-502. [DOI: 10.1016/j.hlc.2017.02.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 11/21/2016] [Accepted: 02/14/2017] [Indexed: 11/24/2022]
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Ad N, Holmes SD, Massimiano PS, Rongione AJ, Fornaresio LM, Fitzgerald D. The use of del Nido cardioplegia in adult cardiac surgery: A prospective randomized trial. J Thorac Cardiovasc Surg 2018; 155:1011-1018. [PMID: 29246552 PMCID: PMC5929134 DOI: 10.1016/j.jtcvs.2017.09.146] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The del Nido cardioplegia solution has been used extensively in congenital heart surgery for more than 20 years and more recently for adults. This randomized controlled trial examined whether expanding this technique to adult cardiac surgery confers benefits in surgical workflow and clinical outcome compared with blood-based cardioplegia. METHODS Adult first-time coronary artery bypass grafting (CABG), valve, or CABG/valve surgery patients requiring cardiopulmonary bypass (CPB) were randomized to del Nido cardioplegia (n = 48) or whole blood cardioplegia (n = 41). Primary outcomes assessed myocardial preservation. Troponin I was measured at baseline, 2 hours after CPB termination, 12 and 24 hours after cardiovascular intensive care unit admission. Alpha was set at P < .001. RESULTS Preoperative characteristics were similar between groups, including age, Society of Thoracic Surgeons risk score, CABG, and valve procedures. There was no significant difference on CPB time (97 vs 103 minutes; P = .288) or crossclamp time (70 vs 83 minutes; P = .018). The del Nido group showed higher return to spontaneous rhythm (97.7% vs 81.6%; P = .023) and fewer patients required inotropic support (65.1% vs 84.2%; P = .050), but did not reach statistical significance. Incidence of Society of Thoracic Surgeons-defined morbidity was low, with no strokes, myocardial infarctions, renal failure, or operative deaths. For del Nido group patients, troponin levels did not increase as much as for control patients (P = .040), but statistical significance was not reached. CONCLUSIONS Evidence from this study suggests del Nido cardioplegia use in routine adult cases may be safe, result in comparable clinical outcomes, and streamline surgical workflow. The trend for troponin should be investigated further because it may suggest superior myocardial protection with the del Nido solution.
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Affiliation(s)
- Niv Ad
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa; Adventist HealthCare, Takoma Park, Md; Inova Fairfax Hospital, Falls Church, Va.
| | - Sari D Holmes
- Heart and Vascular Institute, West Virginia University Medicine, Morgantown, WVa
| | | | | | - Lisa M Fornaresio
- Heart and Vascular Institute, West Virginia University Medicine, Morgantown, WVa
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Koeckert MS, Smith DE, Vining PF, Ranganath NK, Beaulieu T, Loulmet DF, Zias E, Galloway AC, Grossi EA. Del Nido cardioplegia for minimally invasive aortic valve replacement. J Card Surg 2018; 33:64-68. [PMID: 29460374 DOI: 10.1111/jocs.13536] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We analyzed the impact and safety of del Nido Cardioplegia (DNC) in patients undergoing minimally invasive aortic valve replacement (MIAVR). METHODS We analyzed all isolated MIAVR replacements from 5/2013-6/2015 excluding re-operative patients. The approach was a hemi-median sternotomy in all patients. Patients were divided into two cohorts, those who received 4:1 crystalloid:blood DNC solution and those in whom standard 1:4 Buckberg-based cardioplegia (WBC) was used. One-to-one propensity case matching of DNC to WBC was performed based on standard risk factors and differences between groups were analyzed using chi-square and non-parametric methods. RESULTS MIAVR was performed in 181 patients; DNC was used in 59 and WBC in 122. Case matching resulted in 59 patients per cohort. DNC was associated with reduced re-dosing (5/59 (8.5%) versus 39/59 (61.0%), P < 0.001) and less total cardioplegia volume (1290 ± 347 mL vs 2284 ± 828 mL, P < 0.001). Antegrade cardioplegia alone was used in 89.8% (53/59) of DNC patients versus 33.9% (20/59) of WBC patients (P < 0.001). Median bypass and aortic cross-clamp times were similar. Clinical outcomes were similar with respect to post-operative hematocrit, transfusion requirements, need for inotropic/pressor support, duration of intensive care unit stay, re-intubation, length of stay, new onset atrial fibrillation, and mortality. CONCLUSIONS Del Nido cardioplegia usage during MIAVR minimized re-dosing and the need for retrograde delivery. Patient safety was not compromised with this technique in this group of low-risk patients undergoing MIAVR.
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Affiliation(s)
- Michael S Koeckert
- Department of Cardiothoracic Surgery, NYU School of Medicine, NYU Langone Health, New York, New York
| | - Deane E Smith
- Department of Cardiothoracic Surgery, NYU School of Medicine, NYU Langone Health, New York, New York
| | - Patrick F Vining
- Department of Cardiothoracic Surgery, NYU School of Medicine, NYU Langone Health, New York, New York
| | - Neel K Ranganath
- Department of Cardiothoracic Surgery, NYU School of Medicine, NYU Langone Health, New York, New York
| | - Thomas Beaulieu
- Department of Cardiothoracic Surgery, NYU School of Medicine, NYU Langone Health, New York, New York
| | - Didier F Loulmet
- Department of Cardiothoracic Surgery, NYU School of Medicine, NYU Langone Health, New York, New York
| | - Elias Zias
- Department of Cardiothoracic Surgery, NYU School of Medicine, NYU Langone Health, New York, New York
| | - Aubrey C Galloway
- Department of Cardiothoracic Surgery, NYU School of Medicine, NYU Langone Health, New York, New York
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, NYU School of Medicine, NYU Langone Health, New York, New York
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Pereira LM, Matte GS, Lutz P, Arnold A, Patterson A. Production Standard and Stability of Compounded Del Nido Cardioplegia Solution. Hosp Pharm 2017; 52:766-773. [PMID: 29276257 DOI: 10.1177/0018578717738510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The del Nido cardioplegia solution (dNCS) was originally developed for pediatric cardiac surgery, being now also used for adult patients. Hospital pharmacies frequently resort to internal dNCS production which has led to an increase in the need for validated parameters for compounding and storage. Objective: This report defines in-house production standards, as well as the stability of dNCS under optimal storage conditions. Methods: All ingredients were sterile and United States Pharmacopeia (USP)/National Formulary (NF) certified. All final bags were quarantined at 4°C for quality control, when 3 of 33 weekly bags were randomly assayed for potassium content. Each lot was only released if all 3 samples were within ±5% of target. Stability testing was performed per USP 797 guidance. Over a 6-month period, 4 different lots and 4 bags from each lot of dNCS were assayed. Each bag was assessed for physical and chemical stability while refrigerated at 4°C, at 35°C in an incubator, and at 70°C under 80% relative humidity. A light exposure arm was also set up at 25°C under 150 lumens. Calibrators of lidocaine, mannitol, and gluconate were freshly prepared and assayed with the samples by Liquid chromatography/Mass spectrometry (LC/MS). Results: Lidocaine concentrations averaged 0.117 mg/mL (95.8% of theoretical) at 4°C for 30 days. At 35°C, they decayed by 67% in 30 days, while at 70°C nearly 50% was lost after the first day. A first-order kinetics was observed with an Arrhenius activation energy of 25 kcal/mol. Degradation products identified under stress conditions were absent in the stable product. Conclusions: The dNCS is stable for at least 30 days under 4°C refrigeration in ethylene vinyl acetate (EVA) bags.
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Affiliation(s)
- Luis M Pereira
- PKLab at Boston Children's Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Gregory S Matte
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Peter Lutz
- Department of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Alana Arnold
- Department of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | - Al Patterson
- Department of Pharmacy, Boston Children's Hospital, Boston, MA, USA
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Kane AE, Howlett SE. Novel cardioprotection strategies for the aged heart: evidence from pre-clinical studies. Clin Exp Pharmacol Physiol 2017; 43:1251-1260. [PMID: 27626269 DOI: 10.1111/1440-1681.12668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/01/2016] [Accepted: 09/09/2016] [Indexed: 11/30/2022]
Abstract
The incidence of cardiovascular disease is rising as the population ages. This has led to an increase in the need to perform cardiac surgery in older patients. However, aged hearts are particularly susceptible to reperfusion injury following periods of myocardial ischaemia that occur during cardiac surgery. Indeed, older adults experience myocardial dysfunction and reduced survival post-surgery compared to younger people and certain groups, including older women and frail older adults, are at particular risk. This highlights the need to design cardioprotective strategies specifically for the ageing heart. Cardioprotection during surgery is often accomplished by perfusing the heart with chemical arresting agents, known as cardioplegic solutions. New protective strategies have been developed and tested in animal models, where cardioplegic solutions have been modified by changing their temperature, chemical components and/or the frequency of delivery. In addition, drugs designed to activate cardioprotective mechanisms or to inhibit mechanisms involved in injury have been added to improve the efficacy of these solutions. However, most experimental studies have developed and optimized cardioplegic solutions in hearts from younger male animals. This review discusses pre-clinical models used to optimize cardioplegic solutions, with an emphasis on the few studies that have used hearts from older animals. Pharmacologic agents that have been shown to enhance the benefits of cardioplegia in younger hearts and could, in theory, protect vulnerable older hearts are also considered. We emphasize the need to conduct studies in frail older animals of both sexes to facilitate translation of laboratory-based observations to the clinic.
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Affiliation(s)
- Alice E Kane
- Department of Pharmacology, Dalhousie University, NS, B3H 4R2, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, NS, B3H 4R2, Canada.,Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, B3H 4R2, Canada.,Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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Hamad R, Nguyen A, Laliberté É, Bouchard D, Lamarche Y, El-Hamamsy I, Demers P. Comparison of Del Nido Cardioplegia with Blood Cardioplegia in Adult Combined Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Raphael Hamad
- Faculty of Medicine, University of Montreal, Montreal, QC Canada
| | - Anthony Nguyen
- Faculty of Medicine, University of Montreal, Montreal, QC Canada
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, QC Canada
| | - Éric Laliberté
- Faculty of Medicine, University of Montreal, Montreal, QC Canada
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, QC Canada
| | - Denis Bouchard
- Faculty of Medicine, University of Montreal, Montreal, QC Canada
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, QC Canada
| | - Yoan Lamarche
- Faculty of Medicine, University of Montreal, Montreal, QC Canada
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, QC Canada
| | - Ismail El-Hamamsy
- Faculty of Medicine, University of Montreal, Montreal, QC Canada
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, QC Canada
| | - Philippe Demers
- Faculty of Medicine, University of Montreal, Montreal, QC Canada
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, QC Canada
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Ramani J, Malhotra A, Wadhwa V, Sharma P, Garg P, Tarsaria M, Pandya H. Single-Dose Lignocaine-Based Blood Cardioplegia in Single Valve Replacement Patients. Braz J Cardiovasc Surg 2017; 32:90-95. [PMID: 28492789 PMCID: PMC5409253 DOI: 10.21470/1678-9741-2016-0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/24/2016] [Indexed: 11/21/2022] Open
Abstract
Objective Myocardial protection is the most important in cardiac surgery. We compared
our modified single-dose long-acting lignocaine-based blood cardioplegia
with short-acting St Thomas 1 blood cardioplegia in patients undergoing
single valve replacement. Methods A total of 110 patients who underwent single (aortic or mitral) valve
replacement surgery were enrolled. Patients were divided in two groups based
on the cardioplegia solution used. In group 1 (56 patients), long-acting
lignocaine based-blood cardioplegia solution was administered as a single
dose while in group 2 (54 patients), standard St Thomas IB (short-acting
blood-based cardioplegia solution) was administered and repeated every 20
minutes. All the patients were compared for preoperative baseline
parameters, intraoperative and all the postoperative parameters. Results We did not find any statistically significant difference in preoperative
baseline parameters. Cardiopulmonary bypass time were 73.8±16.5 and
76.4±16.9 minutes (P=0.43) and cross clamp time were
58.9±10.3 and 66.3±11.2 minutes (P=0.23) in
group 1 and group 2, respectively. Mean of maximum inotrope score was
6.3±2.52 and 6.1±2.13 (P=0.65) in group 1 and
group 2, respectively. We also did not find any statistically significant
difference in creatine-phosphokinase-MB (CPK-MB), Troponin-I levels, lactate
level and cardiac functions postoperatively. Conclusion This study proves the safety and efficacy of long-acting lignocaine-based
single-dose blood cardioplegia compared to the standard short-acting
multi-dose blood cardioplegia in patients requiring the single valve
replacement. Further studies need to be undertaken to establish this
non-inferiority in situations of complex cardiac procedures especially in
compromised patients.
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Affiliation(s)
- Jaydip Ramani
- Department of Cardiovascular and Thoracic Surgery of U.N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Civil hospital Campus, Asarwa, Ahmedabad, India
| | - Amber Malhotra
- Department of Cardiovascular and Thoracic Surgery of U.N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Civil hospital Campus, Asarwa, Ahmedabad, India
| | - Vivek Wadhwa
- Department of Cardiovascular and Thoracic Surgery of U.N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Civil hospital Campus, Asarwa, Ahmedabad, India
| | - Pranav Sharma
- Department of Cardiovascular and Thoracic Surgery of U.N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Civil hospital Campus, Asarwa, Ahmedabad, India
| | - Pankaj Garg
- Department of Cardiovascular and Thoracic Surgery of U.N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Civil hospital Campus, Asarwa, Ahmedabad, India
| | - Malkesh Tarsaria
- Department of Cardiovascular and Thoracic Surgery of U.N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Civil hospital Campus, Asarwa, Ahmedabad, India
| | - Himani Pandya
- Department of Cardiovascular and Thoracic Surgery of U.N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Civil hospital Campus, Asarwa, Ahmedabad, India
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Comparison of del Nido cardioplegia and St. Thomas Hospital solution - two types of cardioplegia in adult cardiac surgery. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 13:295-299. [PMID: 28096823 PMCID: PMC5233756 DOI: 10.5114/kitp.2016.64867] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 10/10/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION St. Thomas' cardioplegic solution No. 2 (ST), although most widely used in adult cardiac surgery, needs to be given at short intervals, causing additional myocardial injury. AIM To determine whether del Nido (DN) cardioplegia, with longer periods of arrest, provides equivalent myocardial protection as compared to ST. MATERIAL AND METHODS The study population comprised 100 patients who underwent elective coronary artery bypass grafting (CABG) or double valve replacement (DVR) surgery between January 2015 and January 2016. The patients were divided into two groups based on the type of cardioplegia administered during surgery: 1) intermittent ST (ST, n = 50) and 2) DN cardioplegia (DN, n = 50). We compared the aortic cross clamp (CC) and cardiopulmonary bypass (CPB) times, number of intra-operative DC shocks required, and postoperative changes in left ventricular ejection fraction (LVEF) in the two groups. RESULTS The aortic cross clamp and bypass times were shorter with DN (110.15 ±36.84 vs. 133.56 ±35.66 and 158.60 ±39.92 vs. 179.81 ±42.36 min respectively, p < 0.05). Fewer cardioplegia doses were required in the DN group vs. the ST group (1.38 ±0.59 vs. 4.15 ±1.26; p = 0.001), while a single cardioplegia dose was given to 35 DN patients (70%) vs. 0 ST patients (p < 0.001). Postoperative LVEF was better preserved in the DN group. CONCLUSIONS The use of DN leads to shorter cross clamp and CPB times, reduces cardioplegia dosage, and provides potentially better myocardial protection in terms of LVEF preservation, with a safety profile comparable to ST cardioplegia.
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Kim JS, Jeong JH, Moon SJ, Ahn H, Hwang HY. Sufficient myocardial protection of del Nido cardioplegia regardless of ventricular mass and myocardial ischemic time in adult cardiac surgical patients. J Thorac Dis 2016; 8:2004-10. [PMID: 27621853 DOI: 10.21037/jtd.2016.06.66] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Del Nido (DN) cardioplegic solution (CPS) has been widely used during pediatric cardiac surgery. However, its use in the field of adult cardiac surgery is not popular yet. We evaluated efficacy of DN cardioplegia in adult cardiac surgical patients. METHODS Fifty-three adult patients (mean age, 54±16 years) who underwent cardiovascular surgery using DN cardioplegia were enrolled. Myocardial troponin I (TnI) level up to three days after surgery and early clinical outcomes were evaluated. Propensity score matching was performed to compare these results with those after surgery using blood cardioplegia (BC). RESULTS DN cardioplegia was infused with an initial dose of 1,126±221 mL, and an additional 500 mL was reinfused in 15 patients 91 minutes after initial infusion. After release of aortic cross clamp (ACC), spontaneous defibrillation was achieved in 94.3% (50/53). The peak TnI level after surgery was 9.8 ng/mL (range, 2.0-90.2 ng/mL). Linear regression models demonstrated that neither left ventricular mass (LVM) nor ACC time was associated with increased level of peak TnI (P=0.928 and 0.595, respectively). Early mortality occurred in one patient (1.9%). Postoperative complications included atrial fibrillation (n=18, 34.0%), acute kidney injury (n=4, 7.5%), low cardiac output syndrome (n=1, 1.9%), and respiratory complications (n=1, 1.9%). Propensity score matching extracted 39 pairs. Spontaneous defibrillation was achieved more frequently in the DN than BC groups (37/39 vs. 12/39, P<0.001). Peak level and serial changes of TnI were not statistically different between the two groups (P=0.085 and 0.959, respectively). There were also no significant differences in early mortality and postoperative complication rates between the two groups. CONCLUSIONS DN cardioplegia is as effective as BC for adult patients in terms of myocardial protection and early clinical outcomes.
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Affiliation(s)
- Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jin Hee Jeong
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sin Ju Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyuk Ahn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
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Najjar M, George I, Akashi H, Nishimura T, Yerebakan H, Mongero L, Beck J, Hill SC, Takayama H, Williams MR. Feasibility and safety of continuous retrograde administration of Del Nido cardioplegia: a case series. J Cardiothorac Surg 2015; 10:176. [PMID: 26612068 PMCID: PMC4662002 DOI: 10.1186/s13019-015-0383-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 11/18/2015] [Indexed: 11/28/2022] Open
Abstract
Background Del Nido (DN) cardioplegia, a calcium-free, hyperkalemic solution containing lidocaine and magnesium has been developed to help reduce intracellular calcium influx and the resulting myocyte damage in the immediate postischemic period following cardiac arrest. DN cardioplegia has been used for pediatric cardiac surgery but its use in complex reoperative surgery has not been studied. We specifically report the outcomes of patients undergoing reoperative cardiac surgery after previous coronary artery bypass grafting with a patent internal mammary artery (IMA). Methods Patients undergoing reoperative cardiac surgery with prior coronary bypass grafting surgery were studied between 2010 and 2013. Fourteen patients were identified who required continued retrograde cardioplegia administration. In all cases, an initial antegrade dose was given, followed by continuous retrograde administration. Demographics, co-morbidities, intra-operative variables including cardioplegia volumes, post-operative complications, and patient outcomes were collected. Results The mean age of all patients was 73.3+/−6.7 years, and 93 % were male. Aortic cross clamp time and cardiopulmonary bypass times were 81+/−35 and 151+/−79 mins, respectively. Antegrade, retrograde and total cardioplegia doses were 1101+/−398, 3096+/−3185 and 4367+/−3751 ml, respectively. An average of 0.93+/−0.92 inotropes and 1.50+/−0.76 pressors were used on ICU admission after surgery. ICU and total hospital lengths of stay were 5.5+/−7.4 and 9.6+/−8.0 days, respectively. Complications occurred in two patients (14 %) (pneumonia and prolonged mechanical ventilation) and new arrhythmias occurred in five patients (36 %) (four new-onset atrial fibrillation and one pulseless electrical activity requiring 2 min of chest compression). No perioperative myocardial infarctions were noted based on electrocardiograms and cardiac serum markers. Postoperatively, left ventricular function was preserved in all patients whereas two patients (14 %) had mild decrease in right ventricular function as assessed by echocardiography. No mortality was observed. Conclusion Del Nido cardioplegia solution provides acceptable myocardial protection for cardiac surgery that requires continuous retrograde cardioplegia administration. DN cardioplegia’s administration in a continuous retrograde fashion with a patent IMA is believed to provide adequate myocardial protection while avoiding injuring the IMA through dissection and clamping.
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Affiliation(s)
- Marc Najjar
- Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, MHB 7GN-435, 177 Fort Washington Ave, New York, 10032, NY, USA.
| | - Isaac George
- Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, MHB 7GN-435, 177 Fort Washington Ave, New York, 10032, NY, USA.
| | - Hirokazu Akashi
- Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, MHB 7GN-435, 177 Fort Washington Ave, New York, 10032, NY, USA.
| | - Takashi Nishimura
- Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, MHB 7GN-435, 177 Fort Washington Ave, New York, 10032, NY, USA.
| | - Halit Yerebakan
- Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, MHB 7GN-435, 177 Fort Washington Ave, New York, 10032, NY, USA.
| | - Linda Mongero
- Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, MHB 7GN-435, 177 Fort Washington Ave, New York, 10032, NY, USA.
| | - James Beck
- Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, MHB 7GN-435, 177 Fort Washington Ave, New York, 10032, NY, USA.
| | - Stephen C Hill
- Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, MHB 7GN-435, 177 Fort Washington Ave, New York, 10032, NY, USA.
| | - Hiroo Takayama
- Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, MHB 7GN-435, 177 Fort Washington Ave, New York, 10032, NY, USA.
| | - Mathew R Williams
- Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York Presbyterian Hospital, MHB 7GN-435, 177 Fort Washington Ave, New York, 10032, NY, USA.
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Vázquez A, Favieres C, Pérez M, Valera F, Torregrosa S, Doñate L, Heredia T, Bel A, Hernandez C, Schuler M, Berbel A, Blanco O, Sepúlveda P, López E, Montero JA. Cardioplejía Del Nido: una estrategia de protección miocárdica segura, eficaz y económica. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sinha P, Jonas RA. Time for a randomized prospective trial of single dose del Nido cardioplegia solution in adults. Perfusion 2015; 31:34-7. [DOI: 10.1177/0267659115608124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ota T, Yerebakan H, Neely RC, Mongero L, George I, Takayama H, Williams MR, Naka Y, Argenziano M, Bacha E, Smith CR, Stewart AS. Short-term outcomes in adult cardiac surgery in the use of del Nido cardioplegia solution. Perfusion 2015; 31:27-33. [DOI: 10.1177/0267659115599453] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: Del Nido cardioplegia in adult cardiac surgery has not been studied although it has been in common use as a “single” dose cardioplegia in pediatric heart surgery. We retrospectively assessed the short-term (in-hospital) clinical outcomes of patients undergoing aortic valve replacement (AVR) using del Nido cardioplegia solution, comparing it to conventional multi-dose whole blood cardioplegia. Methods: We switched our cardioplegia protocol from conventional whole blood cardioplegia exclusively to del Nido solution in May 2011. In 2011, 240 consecutive patients underwent isolated AVR. One hundred and seventy-eight of them were operated on with the use of del Nido cardioplegia (del Nido group) and whole blood cardioplegia (conventional group) was used in the other 62 patients. Isolated AVR was chosen as a cohort because of its relative simplicity and the similarity of surgical techniques among surgeons. Propensity-score matching identified 54 matched pairs for analysis. Results: The retrograde cardioplegia technique was used in 19 cases (35.2%) in the del Nido group and 52 cases (96.3%) in the conventional group (p<0.001). Mean cardiopulmonary bypass time and mean aortic cross-clamp time were significantly shorter in the del Nido group compared to the conventional group: 71 ± 16 min vs. 84 ± 28 min (p<0.01), 52 ± 14 min vs. 60 ± 16 min (p<0.01), respectively. Postoperative inotropic support was required in 11 patients (20.4 %) in the del Nido group and 13 patients (24.1 %) in the conventional group (p=0.82) with no statistical difference. No patient required a postoperative intra-aortic balloon pump and in-hospital mortality was 0% in both groups. There was no significant difference in postoperative complications between the two groups. Conclusions: Short-term outcomes in adult cardiac surgery using del Nido solution were acceptable and comparable to conventional multi-dose whole blood cardioplegia. The del Nido cardioplegia technique was associated with shortened cross-clamp times and less frequent utilization of the retrograde cardioplegia delivery technique.
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Affiliation(s)
- Takeyoshi Ota
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
- Department of Surgery, Section of Cardiac & Thoracic Surgery, The University of Chicago, Chicago, IL, USA
| | - Halit Yerebakan
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
| | - Robert C Neely
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
| | - Linda Mongero
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
| | - Isaac George
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
| | - Hiroo Takayama
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
| | - Mathew R Williams
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
- Departments of Medicine and Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
| | - Michael Argenziano
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
| | - Emile Bacha
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
| | - Craig R Smith
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
| | - Allan S Stewart
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, New York, NY, USA
- Department of Cardiothoracic Surgery, The Mount Sinai School of Medicine, New York, NY, USA
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Yammine M, Neely RC, Loberman D, Rajab TK, Grewal A, McGurk S, Fitzgerald D, Aranki SF. The Use of Lidocaine Containing Cardioplegia in Surgery for Adult Acquired Heart Disease. J Card Surg 2015. [PMID: 26198086 DOI: 10.1111/jocs.12597] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Del Nido cardioplegia, a crystalloid-based solution with lidocaine as a key element, is given as a single dose and has been used successfully in congenital cardiac surgery. HYPOTHESIS We retrospectively compared a lidocaine containing "modified del Nido" solution with our standard whole blood cardioplegia to investigate its safety and efficacy in adult cardiac surgery. METHODS From June 1, 2013 to December 30, 2013, we used a single dose of lidocaine containing cardioplegia (LC group) in 92 consecutive operations. Propensity matching analysis was undertaken to compare the outcomes of such patients with those who underwent their surgery by the same surgeon using standard whole blood cardioplegia (WB group), n = 396. Propensity score matching yielded 79 pairs of patients. RESULTS After propensity matching, LC and WB groups were similar in baseline operative characteristics including cross-clamp time (LC: 65 minutes [range 54 to 89] vs. WB: 70 minutes [54 to 86], p = 0.993). Postoperative outcomes were similar including inotropic requirements (30.4% [24/72] vs. 25.3% [20/72], p < 0.60), median ventilation time (4.7 hours vs. 5.3, p < 0.74) and median length of stay was seven days for both groups (p < 0.82). Despite higher median postoperative, 24-hour CK-MB levels LC group (LC:22.3 ng/ml, range [15.6 to 40.3] vs. WB:18.4 ng/ml [13.9 to 28.2], p = 0.040), operative and one-year mortality were comparable among study groups (both p > 0.798). CONCLUSIONS Lidocaine containing cardioplegia appears to be safe in adults undergoing cardiac procedure when administered for the first 60 minutes of aortic cross clamping. Higher CK-MB levels did not translate into adverse clinical outcomes.
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Affiliation(s)
- Maroun Yammine
- Division of Cardiac Surgery, The Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert C Neely
- Division of Cardiac Surgery, The Brigham and Women's Hospital, Boston, Massachusetts
| | - Dan Loberman
- Division of Cardiac Surgery, The Brigham and Women's Hospital, Boston, Massachusetts
| | - Taufiek Konrad Rajab
- Division of Cardiac Surgery, The Brigham and Women's Hospital, Boston, Massachusetts
| | - Amardeep Grewal
- Division of Cardiac Surgery, The Brigham and Women's Hospital, Boston, Massachusetts
| | - Siobhan McGurk
- Division of Cardiac Surgery, The Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel Fitzgerald
- Division of Cardiac Surgery, The Brigham and Women's Hospital, Boston, Massachusetts
| | - Sary F Aranki
- Division of Cardiac Surgery, The Brigham and Women's Hospital, Boston, Massachusetts
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Govindapillai A, Hancock Friesen C, O’Blenes SB. Protecting the aged heart during cardiac surgery: single-dose del Nido cardioplegia is superior to multi-dose del Nido cardioplegia in isolated rat hearts. Perfusion 2015; 31:135-42. [DOI: 10.1177/0267659115588633] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Aged hearts are particularly vulnerable to reperfusion injury. We recently showed that single-dose del Nido cardioplegia was superior to ‘standard’ multi-dose 4:1 blood cardioplegia in aged rat hearts. This study seeks to determine if multi-dose del Nido cardioplegia offers additional benefits over single-dose del Nido cardioplegia. Methods: Functional recovery after 60 min of cardioplegic arrest was assessed in isolated, working, senescent rat hearts. Single-dose del Nido cardioplegia (n=14) was compared to multi-dose del Nido cardioplegia (n=12) delivered every 20 min. Results: Troponin release during reperfusion was similar in the single (0.263±0.056 ng/ml) and multi-dose groups (0.261±0.055 ng/ml). Although functional recovery was similar early after reperfusion (stroke work 91±6 ml*mmHg*g−1 vs. 91±8 ml*mmHg*g−1 for single- vs. multi-dose), it declined over time in the multi-dose group (71±9 vs. 43±9 ml*mmHg*g−1 at 60 min, p=0.0175) Conclusions: In aged rat hearts, a single-dose del Nido cardioplegia strategy results in superior functional recovery compared to a multi-dose del Nido cardioplegia strategy.
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Affiliation(s)
- Arun Govindapillai
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada
| | - Camille Hancock Friesen
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Stacy B O’Blenes
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
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Thorsteinsson K, Fonager K, Mérie C, Gislason G, Køber L, Torp-Pedersen C, Mortensen RN, Andreasen JJ. Age-dependent trends in postoperative mortality and preoperative comorbidity in isolated coronary artery bypass surgery: a nationwide study. Eur J Cardiothorac Surg 2015; 49:391-7. [PMID: 25698155 DOI: 10.1093/ejcts/ezv060] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/14/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES An increasing number of octogenarians are being subjected to coronary artery bypass grafting (CABG). The purpose of this study was to examine age-dependent trends in postoperative mortality and preoperative comorbidity over time following CABG. METHODS All patients who underwent isolated CABG surgery between January 1996 and December 2012 in Denmark were included. Patients were identified through nationwide administrative registers. Age was categorized into five different groups and time into three periods to see if mortality and preoperative comorbidity had changed over time. Predictors of 30-day mortality were analysed in a multivariable Cox proportional-hazard models and survival at 1 and 5 years was estimated by Kaplan-Meier curves. RESULTS A total of 38 830 patients were included; the median age was 65.4 ± 9.5 years, increasing over time to 66.6 ± 9.5 years. Males comprised 80%. The number of octogenarians was 1488 (4%). The median survival was 14.7 years (60-69 years), 10.7 years (70-74 years), 8.9 years (75-79 years) and 7.2 years (≥80 years). The 30-day mortality rate was 3%, increasing with age (1% in patients <60 years, 8% in octogenarians). The long-term mortality rate at 1 and 5 years was 2 and 7% (age <60 years) and 14 and 36% (age >80 years), respectively. The proportion of patients >75 years increased from 10 to 20% during the study period as well as the proportion of patients undergoing urgent or emergency surgery. The burden of comorbidities increased over time, e.g. congestive heart failure 13-17%, diabetes 12-21%, stroke 9-11%, in all age groups. Age and emergency surgery were the main predictors of 30-day mortality: age >80 years [hazard ratio (HR): 5.75, 95% confidence interval (CI): 4.41-7.50], emergency surgery (HR: 5.23, 95% CI: 4.38-6.25). CONCLUSION Patients are getting older at the time of surgery and have a heavier burden of comorbidities than before. The proportion of patients undergoing urgent or emergency surgery increased with age and over time. Despite this, the 30-day mortality decreased over time and long-term survival increased, except in octogenarians where it was stable. Octogenarians had substantially higher 30-day mortality compared with younger patients but surgery can be performed with acceptable risks and good long-term outcomes.
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Affiliation(s)
- Kristinn Thorsteinsson
- Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Gentofte, Denmark
| | - Charlotte Mérie
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Rikke N Mortensen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jan J Andreasen
- Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Mick SL, Robich MP, Houghtaling PL, Gillinov AM, Soltesz EG, Johnston DR, Blackstone EH, Sabik JF. del Nido versus Buckberg cardioplegia in adult isolated valve surgery. J Thorac Cardiovasc Surg 2015; 149:626-634; discussion 634-6. [DOI: 10.1016/j.jtcvs.2014.10.085] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/07/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
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50
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Ad N. del Nido cardioplegia: ready for prime time in adult cardiac surgery? J Thorac Cardiovasc Surg 2014; 149:637-8. [PMID: 25726885 DOI: 10.1016/j.jtcvs.2014.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Niv Ad
- Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, Va.
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