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Sanetra K, Gerber W, Domaradzki W, Mazur M, Synak M, Kubaszewska M, Kaźmierczak P, Buszman PP, Bochenek A. Use of del Nido cardioplegia in acute coronary syndrome cases with decreased ejection fraction. Perfusion 2024; 39:353-361. [PMID: 36472195 DOI: 10.1177/02676591221144166] [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: 12/22/2023]
Abstract
BACKGROUND There has been increasing interest in using del Nido cardioplegia in adult cardiac surgery. However, there is limited evidence for its efficacy in patients with acute coronary syndrome and reduced ejection fraction. METHODS This study examined patients with decreased ejection fraction (EF < 40%) who were hospitalized due to acute coronary syndrome and received either del Nido (DN) or cold blood cardioplegia (CB). The patients were matched based on age, gender, myocardial infarction at baseline, and number of conducted surgical procedures. An analysis was conducted on postoperative biomarker release (high-sensitivity troponin T and isoenzyme creatine kinase-MB (CK-MB)), changes in myocardial contractility and perioperative outcomes. RESULTS 62 pairs of patients with similar baseline characteristics were selected. 51.6% of pairs underwent isolated coronary artery bypass grafting, while 48.4% underwent a complex procedure. Postoperative troponin values did not differ significantly at 12 h (median (IQR): 606.7 (381.4-974.8) pg/mL vs. 552 (231.8-1579.5) pg/mL; p = 0.913), nor did CK-MB (median (IQR): 24.3 (12.6-45.5) ng/mL vs. 23.7 (12.3-49.8) ng/mL; p = 0.972). The postoperative EF was similar between groups (median (IQR): 30% (30-35%) vs. 34% (30-38%); p = 0.323). No difference in perioperative mortality, myocardial infarction, stroke, or composite endpoint was noted. In a multivariate analysis, the cardioplegia protocol did not affect biomarker release or changes in ejection fraction. The first stage of acute kidney injury was more frequent in the CB group (28.5% vs. 9.7%, p = 0.033). CONCLUSIONS Both del Nido and cold blood cardioplegia provide adequate cardioprotection in patients with acute coronary syndrome with decreased ejection fraction.
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Affiliation(s)
- Krzysztof Sanetra
- Clinic of Cardiovascular Surgery, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Witold Gerber
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
- Department of Cardiac Surgery, Academy of Silesia, Katowice, Poland
| | - Wojciech Domaradzki
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Marta Mazur
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Magdalena Synak
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Marta Kubaszewska
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | | | - Piotr P Buszman
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow 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
| | - Andrzej Bochenek
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
- Department of Cardiac Surgery, Academy of Silesia, Katowice, Poland
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
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Willekes H, Parker J, Neill J, Augustin G, Fanning J, Spurlock D, Murphy E, Leung S, Boeve T, Leacche M, Willekes C, Timek T. Efficacy of del Nido cardioplegia in adult cardiac procedures with prolonged aortic crossclamp time. J Thorac Cardiovasc Surg 2024; 167:996-1007.e4. [PMID: 35660325 DOI: 10.1016/j.jtcvs.2022.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 01/16/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Equivalent myocardial protection and clinical outcomes have been shown with the use of del Nido cardioplegia (DC) compared with blood cardioplegia (BC) in adult isolated coronary artery bypass grafting and valve patients. However, its safety and efficacy in cardiac procedures with aortic crossclamp times >90 minutes is still unknown. METHODS From May 2014 to September 2019, 2506 adult patients at our center underwent cardiac surgery requiring prolonged aortic crossclamp time defined as 90 minutes or longer. Myocardial protection was achieved with BC in 1955 patients and DC in 551 patients. Two surgeons used DC exclusively and 5 used blood exclusively over the study period. BC was delivered anterograde and retrograde whereas DC was delivered anterograde only. Propensity score matching of several preoperative characteristics, including primary cardiac pathology, yielded 526 well matched pairs. Emergency and reoperative cases were included. Troponin T levels were drawn at 12 hours postoperative in all patients. Clinical data were extracted from our local Society of Thoracic Surgeons database. Subgroup analyses were performed on the basis of crossclamp time stratification. RESULTS For the propensity score-matched cohort, the median crossclamp time was longer in the BC compared with the DC group (114 [interquartile range (IQR), 100-145] minutes for DC vs 153 [IQR, 122-200] minutes for BC; P < .0001) whereas intraoperative peak glucose was higher with BC (173 [IQR, 147-200] g/dL for DC vs 197 [IQR, 171-228] g/dL for BC; P < .001). In addition, perioperative mortality (3.4% vs 3.0%; P = .7273), stroke (3.2% vs 2.1%; P = .2504), renal failure (6.5% vs 4.6%; P = .1767), atrial fibrillation (34% vs 31.4%, P = .3575), intra-aortic balloon pump use (5.3% vs 4.6%, P = .5694), and extracorporeal membrane oxygenation use (3.0% vs 2.9%, P = .8596) did not differ between DC and BC. Postoperative troponin T levels were 0.53 (IQR, 0.30-0.96) ng/mL and 0.62 (IQR, 0.38-1.07) ng/mL for DC and BC, respectively (P = .0024). Subgroup analysis revealed higher troponin T levels with DC for crossclamp times between 150 and 180 minutes. Survival rates at 1, 2, and 5 years were 93.3%, 91.1%, and 78.7% for DC and 94.5%, 91.8%, and 81.5% for BC, respectively (P = .5140). CONCLUSIONS In adult cardiac surgical procedures with aortic crossclamp times >90 minutes, comparable myocardial protection, perioperative mortality and morbidity, and distant survival were observed with the use of DC compared with BC. Higher troponin levels were seen in DC patients with crossclamp times between 150 and 180 minutes, but this was not associated with increased mortality.
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Affiliation(s)
- Holliann Willekes
- Michigan State University College of Human Medicine, Grand Rapids, Mich
| | | | - Jere Neill
- Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Gabriel Augustin
- Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Justin Fanning
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich
| | - David Spurlock
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich
| | - Edward Murphy
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich
| | - Stephane Leung
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich
| | - Theodore Boeve
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich
| | - Charles Willekes
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich
| | - Tomasz Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich.
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Sanetra K, Gerber W, Mazur M, Kubaszewska M, Pietrzyk E, Buszman PP, Kaźmierczak P, Bochenek A. Del Nido vs. Cold Blood Cardioplegia for High-Risk Isolated Coronary Artery Bypass Grafting in Patients with Reduced Ventricular Function. Braz J Cardiovasc Surg 2024; 39:e20220346. [PMID: 38315052 PMCID: PMC10836820 DOI: 10.21470/1678-9741-2022-0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/16/2023] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION The evidence for using del Nido cardioplegia protocol in high-risk patients with reduced ejection fraction undergoing isolated coronary surgery is insufficient. METHODS The institutional database was searched for isolated coronary bypass procedures. Patients with ejection fraction < 40% were selected. Propensity matching (age, sex, infarction, number of grafts) was used to pair del Nido (Group 1) and cold blood (Group 2) cardioplegia patients. Investigation of biomarker release, changes in ejection fraction, mortality, stroke, perioperative myocardial infarction, composite endpoint (major adverse cardiac and cerebrovascular events), and other perioperative parameters was performed. RESULTS Matching allowed the selection of 45 patient pairs. No differences were noted at baseline. After cross-clamp release, spontaneous sinus rhythm return was observed more frequently in Group 1 (80% vs. 48.9%; P=0.003). Troponin values were similar in both groups 12 and 36 hours after surgery, as well as creatine kinase at 12 hours. A trend favored Group 1 in creatine kinase release at 36 hours (median 4.9; interquartile range 3.8-9.6 ng/mL vs. 7.3; 4.5-17.5 ng/mL; P=0.085). Perioperative mortality, rates of myocardial infarction, stroke, or major adverse cardiac and cerebrovascular events were similar. No difference in postoperative ejection fraction was noted (median 35.0%; interquartile range 32.0-38.0% vs. 35.0%; 32.0-40.0%; P=0.381). There was a trend for lower atrial fibrillation rate in Group 1 (6.7% vs. 17.8%; P=0.051). CONCLUSION The findings indicate that del Nido cardioplegia provides satisfactory protection in patients with reduced ejection fraction undergoing coronary bypass surgery. Further prospective trials are required.
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Affiliation(s)
- Krzysztof Sanetra
- Division of Cardiovascular Surgery, Andrzej Frycz Modrzewski Krakow
University, Krakow, Poland
- Department of Cardiac Surgery, American Heart of Poland,
Bielsko-Biała, Poland
| | - Witold Gerber
- Department of Cardiac Surgery, American Heart of Poland,
Bielsko-Biała, Poland
- Department of Cardiac Surgery, Academy of Silesia, Katowice, Poland
| | - Marta Mazur
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow
University, Krakow, Poland
| | - Marta Kubaszewska
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow
University, Krakow, Poland
| | - Ewa Pietrzyk
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow
University, Krakow, Poland
| | - Piotr Paweł Buszman
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow
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
| | | | - Andrzej Bochenek
- Department of Cardiac Surgery, American Heart of Poland,
Bielsko-Biała, Poland
- Department of Cardiac Surgery, Academy of Silesia, Katowice, Poland
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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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Sajja LR, Mannam G, Kamtam DN, Dandu SR, Pathuri S, Saikiran KVSS, Nagalla B, Sompalli S, Ghanta S. Del Nido cardioplegia versus blood cardioplegia in coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 2024; 40:33-41. [PMID: 38125324 PMCID: PMC10728381 DOI: 10.1007/s12055-023-01584-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose The del Nido cardioplegia (DC) has been extensively used in congenital heart surgery for over two decades and is becoming popular in adult cardiac surgery. We evaluated the efficacy and safety of DC, compared to conventional blood cardioplegia (BC), in adult patients undergoing isolated coronary artery bypass grafting (CABG). Methods This metachronous study included a total of 2330 consecutive patients who underwent isolated CABG. The study population was divided into two groups: BC group, consisting of 1165 patients (May 2012 through December 2015); and DC (del Nido) cardioplegia group consisting of 1165 patients (January 2016 through June 2018). Propensity matching yielded 735 well-matched pairs. The propensity-matched cohorts of BC and DC were compared in terms of myocardial function outcomes and other clinical outcomes to determine the efficacy and safety of both the cardioplegic solutions. Results There was no difference in 30-day mortality [odds ratio (OR), 0.74; 95% confidence interval (CI), 0.16-3.35, p = 0.70]. There was a significant decrease in the DC group in the postoperative events, including re-exploration rates [OR, 0.25; 95% CI, 0.118-0.568, p < 0.001], myocardial infarction [OR, 0.282; 95% CI, 0.133-0.596, p < 0.001], left ventricular dysfunction [OR, 0.60; 95% CI, 0.396-0.916, p = 0.018], and acute kidney injury (AKI) [OR, 0.255; 95% CI, 0.156-0.418, p < 0.001]. The rate of spontaneous return to sinus rhythm was significantly higher in the DC group [OR, 5.162; 95% CI, 3.701-7.198, p < 0.001]. Cardiopulmonary bypass time (95.2 ± 29.1 min vs. 82.1 ± 28.8 min, p < 0.001) and aortic cross-clamp (ACC) time (57.3 ± 19 min vs. 48.7 ± 19.0 min, p < 0.001) were higher in the DC group, but the absolute difference in ACC time was only 8 min. There was no difference in AKI requiring renal replacement therapy [OR, 0.62; 95% CI, 0.203-1.912, p = 0.40], postoperative cerebrovascular accidents [OR, 0.398; 95% CI, 0.077-2.059, p = 0.073], and postoperative ventricular arrhythmias [OR, 0.80; 95% CI, 0.456-1.916, p = 0.47]. Conclusion This study revealed comparable clinical outcomes and effective myocardial protection with DC, compared to BC in patients undergoing isolated CABG. In addition, DC demonstrated the ease of administration with the feasibility of single-dose administration.
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Affiliation(s)
- Lokeswara Rao Sajja
- Division of Cardiothoracic Surgery, Star Hospitals, Road No. 10, Banjara Hills, Hyderabad, 500034 Telangana India
- Division of Clinical Research in Cardiovascular Medicine/Surgery, Sajja Heart Foundation, Srinagar Colony, Hyderabad, 500073 India
| | - Gopichand Mannam
- Division of Cardiothoracic Surgery, Star Hospitals, Road No. 10, Banjara Hills, Hyderabad, 500034 Telangana India
| | - Devanish Narasimhasanth Kamtam
- Division of Clinical Research in Cardiovascular Medicine/Surgery, Sajja Heart Foundation, Srinagar Colony, Hyderabad, 500073 India
| | - SatyaBhaskara Raju Dandu
- Division of Cardiothoracic Surgery, Star Hospitals, Road No. 10, Banjara Hills, Hyderabad, 500034 Telangana India
| | - Satyendranath Pathuri
- Division of Cardiothoracic Surgery, Star Hospitals, Road No. 10, Banjara Hills, Hyderabad, 500034 Telangana India
| | | | - Balakrishna Nagalla
- Division of Statistics, Sajja Heart Foundation, Srinagar Colony, Hyderabad, 500073 India
| | - Sriramulu Sompalli
- Division of Anesthesiology, Star Hospitals, Road No. 10, Banjara Hills, Hyderabad, 500034 India
| | - Satyanarayana Ghanta
- Department of Perfusion Technology, Star Hospitals, Road No. 10, Banjara Hills, Hyderabad, 500034 India
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Diao H, Dai W, Wurm D, Lu Y, Shrestha L, He A, Wong RK, Chen QM. Del Nido cardioplegia or potassium induces Nrf2 and protects cardiomyocytes against oxidative stress. Am J Physiol Cell Physiol 2023; 325:C1401-C1414. [PMID: 37842750 PMCID: PMC10861178 DOI: 10.1152/ajpcell.00436.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
Open heart surgery is often an unavoidable procedure for the treatment of coronary artery disease. The procedure-associated reperfusion injury affects postoperative cardiac performance and long-term outcomes. We addressed here whether cardioplegia essential for cardiopulmonary bypass surgery activates Nrf2, a transcription factor regulating the expression of antioxidant and detoxification genes. With commonly used cardioplegic solutions, high K+, low K+, Del Nido (DN), histidine-tryptophan-ketoglutarate (HTK), and Celsior (CS), we found that DN caused a significant increase of Nrf2 protein in AC16 human cardiomyocytes. Tracing the ingredients in DN led to the discovery of KCl at the concentration of 20-60 mM capable of significant Nrf2 protein induction. The antioxidant response element (ARE) luciferase reporter assays confirmed Nrf2 activation by DN or KCl. Transcriptomic profiling using RNA-seq revealed that oxidation-reduction as a main gene ontology group affected by KCl. KCl indeed elevated the expression of classical Nrf2 downstream targets, including TXNRD1, AKR1C, AKR1B1, SRXN1, and G6PD. DN or KCl-induced Nrf2 elevation is Ca2+ concentration dependent. We found that KCl decreased Nrf2 protein ubiquitination and extended the half-life of Nrf2 from 17.8 to 25.1 mins. Knocking out Keap1 blocked Nrf2 induction by K+. Nrf2 induction by DN or KCl correlates with the protection against reactive oxygen species generation or loss of viability by H2O2 treatment. Our data support that high K+ concentration in DN cardioplegic solution can induce Nrf2 protein and protect cardiomyocytes against oxidative damage.NEW & NOTEWORTHY Open heart surgery is often an unavoidable procedure for the treatment of coronary artery disease. The procedure-associated reperfusion injury affects postoperative cardiac performance and long-term outcomes. We report here that Del Nido cardioplegic solution or potassium is an effective inducer of Nrf2 transcription factor, which controls the antioxidant and detoxification response. This indicates that Del Nido solution is not only essential for open heart surgery but also exhibits cardiac protective activity.
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Affiliation(s)
- Hongting Diao
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Wujing Dai
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Daniel Wurm
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Yingying Lu
- Interdisciplinary Program in Statistics and Data Science, University of Arizona, Tucson, Arizona, United States
| | - Lenee Shrestha
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Amy He
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Raymond K Wong
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Qin M Chen
- Perfusion Sciences Graduate Program, Department of Pharmacology College of Medicine, University of Arizona, Tucson, Arizona, United States
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Garcia-Suarez J, Garcia-Fernandez J, Martinez Lopez D, Reques L, Sanz S, Carballo D, Martin CE, Ospina VM, Villar S, Martin A, Casado M, Villafranca A, Gonzalez AI, Serrano S, Forteza A. Clinical impact of del Nido cardioplegia in adult cardiac surgery: A prospective randomized trial. J Thorac Cardiovasc Surg 2023; 166:1458-1467. [PMID: 35279289 DOI: 10.1016/j.jtcvs.2022.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 01/09/2022] [Accepted: 01/23/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study objective was to assess the benefits of del Nido cardioplegia compared with cold blood cardioplegia solution in terms of myocardial protection during adult cardiac surgery. METHODS A total of 474 adult patients undergoing coronary artery bypass grafting, heart valve surgery, thoracic aortic surgery, or combined procedures were randomized to the del Nido cardioplegia group (n = 234) or the cold blood cardioplegia solution group (n = 240) after provided informed consent. The primary end points assessed inotropic support requirements, severe cardiovascular events, and troponin trend within the first 48 hours of intensive care unit stay. Reperfusion arrhythmias, aortic crossclamp and cardiopulmonary bypass times, and other clinical perioperative variables were considered as secondary end points. RESULTS No statistically significant differences were found regarding postoperative inotropic support requirements or the incidence of severe cardiovascular events. The del Nido cardioplegia group showed a higher return to spontaneous sinus rhythm (P< .001), a lower number of defibrillation attempts (P< .001), and an earlier peak troponin value in the postoperative period. Peak blood glucose levels and intravenous insulin requirements were significantly lower in the del Nido cardioplegia group. We found no significant differences regarding aortic crossclamp or cardiopulmonary bypass time. We did observe a lower incidence of postoperative stroke in the del Nido cardioplegia group (2.6% vs 6.7%; P= .035). CONCLUSIONS del Nido cardioplegia can be used safely and with comparable outcomes compared with traditional cardioplegia solutions. Additional advantages over glycemic control, reperfusion arrhythmias, and its comfortable redosing interval make del Nido an interesting alternative for myocardial protection in adult cardiac surgery. A significant decrease in postoperative stroke will require further research to shed light on the results of this study. VIDEO ABSTRACT.
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Affiliation(s)
- Jessica Garcia-Suarez
- Department of Anesthesiology and Critical Care, Puerta de Hierro University Hospital, Madrid, Spain.
| | - Javier Garcia-Fernandez
- Department of Anesthesiology and Critical Care, Puerta de Hierro University Hospital, Madrid, Spain
| | | | - Leticia Reques
- Cardiac Surgery Perfusion Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Sergio Sanz
- Department of Anesthesiology and Critical Care, Puerta de Hierro University Hospital, Madrid, Spain
| | - Daniel Carballo
- Department of Anesthesiology and Critical Care, Puerta de Hierro University Hospital, Madrid, Spain
| | | | - Victor Manuel Ospina
- Department of Cardiac Surgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Susana Villar
- Department of Cardiac Surgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Ana Martin
- Cardiac Surgery Perfusion Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Maria Casado
- Department of Anesthesiology and Critical Care, Puerta de Hierro University Hospital, Madrid, Spain
| | - Ana Villafranca
- Department of Anesthesiology and Critical Care, Puerta de Hierro University Hospital, Madrid, Spain
| | - Ana Isabel Gonzalez
- Department of Anesthesiology and Critical Care, Puerta de Hierro University Hospital, Madrid, Spain
| | - Santiago Serrano
- Department of Cardiac Surgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Alberto Forteza
- Department of Cardiac Surgery, Puerta de Hierro University Hospital, Madrid, Spain
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Stoitsev G, Gavrilov V, Goranovska V, Manchev G, Gegouskov V. Cold modified Del Nido cardioplegia in adults undergoing elective cardiac coronary surgery. Folia Med (Plovdiv) 2023; 65:760-769. [PMID: 38351758 DOI: 10.3897/folmed.65.e90286] [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] [Received: 07/13/2022] [Accepted: 09/12/2022] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION The cardioplegic solution of Kirklin (Kn) is frequently used in adult cardiosurgical patients. It requires reinfusion at short intervals, which causes further difficulty during surgery and the quality of myocardial protection is often called into question.
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9
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Nakai C, Zhang C, Kitahara H, Shults C, Waksman R, Molina EJ. Outcomes of del Nido cardioplegia after surgical aortic valve replacement and coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2023; 71:491-497. [PMID: 36843184 DOI: 10.1007/s11748-023-01914-x] [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] [Received: 11/29/2022] [Accepted: 02/08/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVE The use of del Nido cardioplegia (DNC) was initially adopted in the field of pediatric cardiac surgery. Several studies in adult patients suggested there were no differences in early postoperative outcomes as compared to blood-based cardioplegia. We sought to evaluate the impact of DNC as compared to modified Buckberg cardioplegia (BC) on early postoperative outcomes in patients undergoing surgical aortic valve replacement with and without coronary artery bypass grafting (SAVR ± CABG). METHODS All SAVR ± CABG procedures were switched from BC to DNC at our institute in 2012. We compared outcomes of BC (November 2007-October 2012; n = 1037) with DNC (November 2012-December 2017; n = 1067). Significant baseline differences were observed between the two groups and such differences were adjusted via inverse propensity treatment weighting. RESULTS After adjustment, SAVR ± CABG patients who received DNC required longer aortic cross-clamp times, while postoperative peak troponin I and creatinine kinase-MB isotype were significantly lower in the BC group. Length of hospital and intensive care unit stay were significantly shorter in the DNC group. The incidence of postoperative complications was lower in the DNC cohort. Thirty-day mortality rate was significantly lower in the DNC group (3.0% vs 4.9%, p = 0.002). CONCLUSIONS The use of DNC cardioplegia in our cohort of adult patients who underwent SAVR ± CABG was safe and associated with improved postoperative outcomes. However, the use of DNC may be associated with higher degrees of myocardial injury.
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Affiliation(s)
- Chikashi Nakai
- Division of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Cheng Zhang
- Division of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hiroto Kitahara
- Division of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Christian Shults
- Division of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ezequiel J Molina
- Division of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
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Malvindi PG, Tian DH, Bifulco O, Berretta P, Alfonsi J, Cefarelli M, Yan TD, Di Eusanio M. del Nido versus blood cardioplegia in adult cardiac surgery: a meta-analysis. J Cardiovasc Med (Hagerstown) 2023; 24:522-529. [PMID: 37409597 DOI: 10.2459/jcm.0000000000001506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
AIMS Initially developed for myocardial protection in immature cardiomyocytes, del Nido cardioplegia has been increasingly used over the past decade in adult patients. Our aim is to analyse the results from randomized controlled trials and observational studies comparing early mortality and postoperative troponin release in patients who underwent cardiac surgery using del Nido solution and blood cardioplegia. METHODS A literature search was performed through three online databases between January 2010 and August 2022. Clinical studies providing early mortality and/or postoperative troponin evaluation were included. A random-effects meta-analysis with a generalized linear mixed model, incorporating random study effects, was implemented to compare the two groups. RESULTS Forty-two articles were included in the final analysis for a total of 11 832 patients, 5926 of whom received del Nido solution and 5906 received blood cardioplegia. del Nido and blood cardioplegia populations had comparable age, gender distribution, history of hypertension and diabetes mellitus. There was no difference in early mortality between the two groups. There was a trend towards lower 24 h [mean difference -0.20; 95% confidence interval (CI) -0.40 to 0.00; I2 = 89%; P = 0.056] and lower peak postoperative troponin levels (mean difference -0.10; 95% CI -0.21 to 0.01; I2 = 0.87; P = 0.087) in the del Nido group. CONCLUSION del Nido cardioplegia can be safely used in adult cardiac surgery. The use of del Nido solution was associated with similar results in terms of early mortality and postoperative troponin release when compared with blood cardioplegia myocardial protection.
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Affiliation(s)
- Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - David H Tian
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital
- Critical Care Division, The George Institute for Global Health, Sydney
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Tristan D Yan
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital
- Sydney Medical School, Sydney University, Sydney, Australia
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy
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11
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Chan J, Oo S, Butt S, Benedetto U, Caputo M, Angelini GD, Vohra HA. Network meta-analysis comparing blood cardioplegia, Del Nido cardioplegia and custodiol cardioplegia in minimally invasive cardiac surgery. Perfusion 2023; 38:464-472. [PMID: 35225070 DOI: 10.1177/02676591221075522] [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: 11/16/2022]
Abstract
INTRODUCTION Minimally invasive cardiac surgery has been evolving, with the intention of reducing surgical trauma, improve cosmesis and patient satisfaction. Single dose, crystalloid cardioplegia such as Del Nido cardioplegia and Custoidol solution have been increasingly used to reduce the interruption from repeating cardioplegia dosing to minimise the cardiopulmonary bypass and cross clamp time. However, the best cardioplegia for myocardial protection in adult minimally invasive cardiac surgery remains controversial. We aimed to conduct a meta-analysis to analyse the current evidence in the literature. METHOD A systematic review and meta-analysis was performed following the updated 2020 PRISMA guideline. Articles published in the five major electronic databases up 1st of April 2021 were identified and reviewed. The primary outcome was in-hospital or 30-day mortality. Traditional pairwise and Bayesian network meta-analyses were conducted. RESULTS Nine articles were included in this study. The use of Del Nido cardioplegia was associated with a lower volume of cardioplegia used (Del Nido vs Blood, 1105.62 mL+/-123.47 vs 2569.46 mL+/-1515.52, p<0.001), cardiopulmonary bypass (Del Nido vs Custoidol vs Blood: 91.67+/-14.78 vs 138.05 +/- 21.30 vs 119.38+/-26.91 minutes, p<0.001) and cross-clamp time (Del Nido vs Custoidol vs Blood: 74.99+/-18.55 vs 82.01 +/- 17.28 vs 93.66+/-8.88 minutes, p < 0.001). No differences were observed in the incidence of in-hospital/30-day mortality rate, new onset of atrial fibrillation and stroke. Ranking analysis showed the Custoidol solution has the highest probability to be the first ranked cardioplegia. CONCLUSION No differences were found between blood and crystalloid cardioplegia in adult minimally invasive cardiac surgery in several clinical outcomes. The cardioplegia of choice in minimally invasive cardiac surgery remains the surgeons' decision and preference.
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Affiliation(s)
- Jeremy Chan
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
| | - Shwe Oo
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
| | - Salman Butt
- Department of Perfusion Sciences, 156611St George's Hospital, London UK
| | - Umberto Benedetto
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, 156596Bristol Royal Hospital for Children, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery, 156594Bristol Heart Institute, Bristol, UK
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12
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Sanetra K, Gerber W, Domaradzki W, Mazur M, Synak M, Pietrzyk E, Buszman PP, Kaźmierczak P, Bochenek A. Del Nido versus cold blood cardioplegia in adult patients with impaired ejection fraction undergoing valvular and complex heart surgery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:112-120. [PMID: 36534124 DOI: 10.23736/s0021-9509.22.12498-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is sparse evidence on the efficacy of del Nido cardioplegia in high-risk patients with reduced ejection fraction undergoing valvular or complex heart surgery, and further investigation is required. METHODS An institutional registry was searched for patients who underwent valvular or complex heart surgery and had an ejection fraction <40%. Subjects who received del Nido cardioplegia (DNC) and cold blood cardioplegia (CBC) were selected. Propensity matching was performed with age, gender, and number of conducted procedures as matching criteria. A comparative analysis was performed on primary endpoints of the troponin rise and changes in ejection fraction (EF). A composite endpoint of a troponin rise of ≥20× baseline or fall of EF≥5% was assessed in a multivariate analysis. Other perioperative complications are reported. RESULTS One hundred patients from the DNC group were matched to the 100 patients in the CBC group. There were no differences between groups at baseline. Postoperatively, lower troponin values were observed in the DNC group at 12 hours (median; IQR: 523.2;349.1-740.4 pg/mL vs. 787.6;443.6-1689.0 pg/mL; P=0.016) and 36 hours (median; IQR: 426.1;337.2-492.1 pg/mL vs. 653.7;398.8-1737.5 pg/mL; P=0.044). Fewer patients in the DNC group had a fall in EF≥5% (7% vs. 16%; P=0.046). The multivariable analysis did not reveal a significant predictor of composite endpoint. CONCLUSIONS In patients with impaired contractility undergoing valvular and complex procedures, the use of del Nido cardioplegia as an alternative to cold blood cardioplegia is associated with lower troponin release and improved preservation of ejection fraction.
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Affiliation(s)
- Krzysztof Sanetra
- Clinic of Cardiovascular Surgery, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland - .,Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland -
| | - Witold Gerber
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland.,Department of Cardiac Surgery, Academy of Silesia, Katowice, Poland
| | - Wojciech Domaradzki
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
| | - Marta Mazur
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Magdalena Synak
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Ewa Pietrzyk
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Piotr P Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland.,Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.,Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland
| | | | - Andrzej Bochenek
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland.,Department of Cardiac Surgery, Academy of Silesia, Katowice, Poland.,Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
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13
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Sazzad F, Ong ZX, Ong GS, Luo HD, Guim Goh S, Kofidis T, Vitaly S. Non-selective Del Nido and St Thomas cardioplegia in adults: analysis of early clinical experience using propensity matching. Ther Adv Cardiovasc Dis 2023; 17:17539447231210713. [PMID: 37991005 PMCID: PMC10666688 DOI: 10.1177/17539447231210713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Del Nido cardioplegia (DNC) is a single-dose, high potassium, low-volume cardioplegia solution that has grown in favor recently. However, the use of DNC in the Asian population may be associated with certain challenges. METHODS Between January 2017 and April 2022, DNC was used for myocardial protection in this single-center retrospective study. In total, 5731 patients underwent open heart surgeries, where 310 patients received DNC for single or multiple procedures. A total of 307 pair of propensity-matched patients from DNC and cold blood St. Thomas cardioplegia (STC) were compared. RESULTS In total, 5085 patients with STC and 310 patients with DNC from the cohort were matched, reflecting the initial group sizes before propensity matching. About 307 patient pairs were included in the final analysis after propensity matching with the interest variables. In the STC group, the requirement for an immediate postoperative intra-aortic balloon pump (IABP) was significantly higher [18 (5.9%) in DNC versus 28 (9.1%) in STC, p = 0.021]. A 30-day mortality was comparable between the DNC and STC groups (2.9% versus 3.3%, p = 1.00). Major adverse cardiac events (MACE) (2.6% versus 3.6%, p = 0.648) showed no difference between the groups. In both single and multiple procedure subgroups, there were no statistically significant differences in 30-day mortality and MACE incidences when comparing STC and DNC. CONCLUSION The use of DNC in adults is acceptable and adaptable. Comparable clinical outcomes between STC patients and DNC were revealed by our investigation. There were no appreciable differences in 30-day mortality or MACE despite the STC group having a much higher need for immediate postoperative IABP.
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Affiliation(s)
- Faizus Sazzad
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Centre for Translational Medicine, MD6, 14 Medical Drive, Level-8 (South), Singapore 117599, Singapore
| | - Zhi Xian Ong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Geok Seen Ong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Hai Dong Luo
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Si Guim Goh
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Theo Kofidis
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
| | - Sorokin Vitaly
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore
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14
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Zhai K, Cheng X, Zhang P, Wei S, Huang J, Wu X, Gao B, Li Y. Del Nido cardioplegia for myocardial protection in adult cardiac surgery: a systematic review and update meta-analysis. Perfusion 2023; 38:6-17. [PMID: 34263684 DOI: 10.1177/02676591211031095] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Although the application of del Nido cardioplegia solution (DNC) in adult cardiac surgery is accumulating, the feasibility and safety of this myocardial protection strategy in adults remains controversial. We aimed to update our previous meta-analysis to determine the myocardial protective effect of DNC versus conventional cardioplegia (CC) in adult cardiac surgery. METHODS A comprehensive literature search was performed using PubMed, EMBASE, the Cochrane Library, and International Clinical Trials Registry Platform databases through November 2020. RESULTS Thirty-seven observational studies and four randomized controlled trials (RCTs) including 21,779 patients were identified. The DNC group was associated with decreased postoperative cardiac enzymes [troponin T (cTnT) and creatine kinase-MB (CK-MB)] [standardized mean differences (SMD): -0.59, 95% confidence interval (CI): -0.99 to -0.19, p = 0.004], cardiopulmonary bypass (CPB) time (MD: -9.31, 95% CI: -13.10 to -5.51, p < 0.00001), aortic cross-clamp (ACC) time (MD: -7.20, 95% CI: -10.31 to -4.09, p < 0.00001), and cardioplegia volume (SMD: -1.95, 95% CI: -2.46 to -1.44, p < 0.00001). Intraoperative defibrillation requirement was less in the DNC group [relative risk (RR): 0.50, 95% CI: 0.33 to 0.75, p = 0.0007]. The pooled analysis revealed no significant difference in operative mortality among the patients assigned to DNC and those undergoing CC. CONCLUSION In adult cardiac surgery, compared to CC, myocardial protection used with DNC yield similar or better short-term clinical outcomes. More high-quality trials and RCTs reflecting long-term follow-up morbidity and mortality are required in the future to confirm these findings.
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Affiliation(s)
- Kerong Zhai
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xingdong Cheng
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Pengbin Zhang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Shilin Wei
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Jian Huang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xiangyang Wu
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Bingren Gao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
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15
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Kang L, Cerullo M. Commentary: All Grown Up - del Nido Cardioplegia Shows Promise in Complex Adult Aortic Surgery. Semin Thorac Cardiovasc Surg 2023; 35:42-43. [PMID: 34774768 DOI: 10.1053/j.semtcvs.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Lillian Kang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Marcelo Cerullo
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; National Clinician Scholars Program, Duke University and Durham Veterans Affairs Medical Center, Durham, North Carolina.
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16
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Willekes H, Parker J, Fanning J, Leung S, Spurlock D, Murphy E, Boeve T, Leacche M, Willekes C, Timek T. Del Nido Cardioplegia in Ascending Aortic Surgery. Semin Thorac Cardiovasc Surg 2023; 35:33-41. [PMID: 34718142 DOI: 10.1053/j.semtcvs.2021.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 11/11/2022]
Abstract
Del Nido cardioplegia offers equivalent myocardial protection and clinical outcomes to blood cardioplegia in adult isolated CABG and valve patients, but the safety and efficacy of del Nido in complex cases with prolonged aortic cross-clamp times is still unknown. 443 patients at our center underwent replacement of the ascending aorta using either del Nido (n = 182) or blood (n = 261) cardioplegia. Two surgeons used del Nido exclusively and 6 used blood exclusively over the study period. Propensity matching of preoperative characteristics yielded 172 well matched pairs. Emergency and reoperative cases were included. Clinical data were extracted from our local database. Troponin levels were drawn at 12 hours postop in all patients. Rates of perioperative mortality (4.7% vs 5.2%), stroke (5.8% vs 7.0%), renal failure (11.6% vs 12.2%), atrial fibrillation (36.0% vs 31.4%), intra-aortic balloon pump insertion (2.3% vs1.2%), and extra corporeal membrane oxygenation use (4.7% vs 4.1%) did not differ between blood and del Nido groups. Postop Troponin T levels were 0.50[0.35, 0.86] ng/mL and 0.40[0.20, 0.70] ng/mL for blood and del Nido, respectively (P < 0.0001). Postop echocardiography was available in 333 of 344 (96.8%) patients, and there was no difference in change in EF from pre- to postop between blood 0.0[-6.0, 5.0]% and del Nido 0.0 [-6.0, 3.5]% (P = 0.201). Subgroup analysis of patients with aortic cross-clamp time greater than 180 minutes (blood = 77, del Nido = 27) revealed no difference in troponins, ejection fraction, or clinical outcomes. Five-year survival was 85.9[76.8, 91.7]% and 79.8[71.2, 86.1]% for blood and del Nido, respectively (P = 0.151). In ascending aortic surgery with prolonged operative times, no differences were observed in myocardial protection or clinical outcomes with the use of del Nido cardioplegia compared to blood cardioplegia.
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Affiliation(s)
- Holliann Willekes
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Jessica Parker
- Office of Research, Spectrum Health, Grand Rapids, Michigan
| | - Justin Fanning
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - Stephane Leung
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - David Spurlock
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - Edward Murphy
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - Theodore Boeve
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - Charles Willekes
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - Tomasz Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan.
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17
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Chung MM, Erwin WC, Ning Y, Zhao Y, Chan C, D'Angelo A, Kossar A, Spellman J, Kurlansky P, Takayama H. A novel dosing strategy of del Nido cardioplegia in aortic surgery. JTCVS OPEN 2022; 10:39-61. [PMID: 35795250 PMCID: PMC9255383 DOI: 10.1016/j.xjon.2022.04.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objective While del Nido (DN) cardioplegia is increasingly used in cardiac surgery, knowledge is limited in its safety profile for operations with prolonged crossclamp time (CCT). We have introduced a unique redosing strategy for aortic surgery: all operations use DN with a 1000-mL initiation dose (750 mL antegrade, 250 mL retrograde) composed of 1:4 blood:DN crystalloid. At 90 minutes CCT and every 30 minutes thereafter, a 250-mL dose was introduced retrograde in a 4:1 (“reverse”) ratio. Additionally, at 90 minutes CCT and every 90 minutes thereafter, a reverse ratio dose of approximately 100 to 400 mL was introduced via the right coronary artery. Here, we analyze the outcomes of our unique redosing strategy used. Methods In total, 440 patients underwent aortic surgery between January 2015 and March 2021 under a single surgeon and received DN. Our primary end points were change in left ventricular ejection fraction (LVEF) and right ventricular systolic function based on echocardiography. Multivariable linear regression was used to analyze the relationship between CCT and outcomes. Results The median was 61 years old (interquartile range, 51-69), and 23% were female. Indication was aneurysm in 65% and dissection in 24%. Median preoperative LVEF was 60% (55%-62%). Median CCT and cardiopulmonary bypass times were 135 minutes (93-165 minutes) and 181 minutes (142-218 minutes), respectively. In-hospital mortality occurred in 3%. Multivariable linear regression showed CCT was not associated with change in LVEF or change in right ventricular systolic function. Conclusions Our unique method of redosing DN cardioplegia appears to provide safe and effective myocardial protection for aortic surgery.
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18
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Gerber W, Sanetra K, Gerber AD, Jankowska-Sanetra J, Kuczera M, Białek K, Buszman PP, Bochenek A. One-shot cardioplegia for minimally invasive mitral valve repair-a comparison of del Nido and Bretschneider Histidine-Tryptophan-Ketoglutarate solutions. Perfusion 2022; 38:763-770. [PMID: 35320027 DOI: 10.1177/02676591221080653] [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: 11/16/2022]
Abstract
BACKGROUND Minimally invasive procedures are demanding in terms of cardioprotection. In many leading centres Bretschneider HTK solution is used for mitral valve surgery. The study was designed to provide comparison of the del Nido and Bretschneider HTK protocol. METHODS Patients who underwent minimally invasive mitral valve repair for primary mitral regurgitation and received single delivery of either del Nido (Group 1) or Bretschneider HTK cardioplegia (Group 2) were matched on basis of age, gender and length of the cross-clamp time. The groups were compared in terms of major adverse cardiac and cerebrovascular events (death, myocardial infarction, stroke), high sensitivity troponin T (hs-TnT) and creatine kinase- MB isoenzyme (CK-MB) release at 12 h and 24 h following the surgery, incidence of low cardiac output syndrome (LCOS), postoperative arrhythmia, transfusions and postoperative renal function. RESULTS Case control matching selected 38 pairs of patients. None of patients died, nor suffered from myocardial infarction or stroke. Troponin values did not differ at 12 h (median: 281.0 pg/mL vs 313.0 pg/mL; p = .38) and 24 h (median: 261.0 pg/mL vs 299.0 pg/mL; p = .54), as well as CK-MB at 12 h (median: 25.0 ng/mL vs 29.0 ng/mL; p = .31) and 24 h (median: 11.0 ng/mL versus 9.6 ng/mL; p = .46). Difference in occurrence of LCOS was insignificant (2 vs 7; 5.2% vs 18.4%; p =.15). No difference was shown in incidence of postoperative arrhythmia, transfusions and renal function. CONCLUSIONS Del Nido cardioplegia can be used safely as an alternative for Bretschneider HTK for minimally invasive mitral valve surgery.
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Affiliation(s)
- Witold Gerber
- Faculty of Medicine, University of Technology, Katowice, Poland.,Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Krzysztof Sanetra
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland.,Clinic of Cardiovascular Surgery, 150516Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | | | | | - Małgorzata Kuczera
- Department of Anaesthesiology and Intensive Care, American Heart of Poland, Bielsko-Biała, Poland
| | - Krzysztof Białek
- Faculty of Medicine, University of Technology, Katowice, Poland.,Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Piotr Paweł Buszman
- Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland.,Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland.,Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Andrzej Bochenek
- Faculty of Medicine, University of Technology, Katowice, Poland.,Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland.,Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
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19
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Prevention of Ischemic Injury in Cardiac Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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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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21
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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: 9] [Impact Index Per Article: 3.0] [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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22
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Kyaruzi M, Demirsoy E. Strategies and pitfalls during minimally invasive total coronary artery revascularization via left anterior minithoracotomy: a promising future. Acta Cardiol 2021; 77:545-550. [PMID: 34392818 DOI: 10.1080/00015385.2021.1965748] [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: 10/20/2022]
Abstract
For many years up to date coronary artery bypass surgery has been performed via sternotomy as a gold standard approach. However recently there has been alternative approaches for coronary artery bypass grafting in minimal invasive ways to reduce complications associated with sternotomy such as sternal wound infections, impared pulmonary functions and cosmetic related problems. Most of these minimal invasive procedures have been associated with long learning curve, high costs and sophiscated instruments used during surgery. Minimal invasive coronary artery bypass grafting via left anterior mini-thoracotomy is equally effective as a gold standard sternotomy with the same principles of suturing techniques and provides a great comfort in many aspects as sternotomy. It is safe and does not require sophiscated tools which require long learning curve and high expanses. This type of surgery requires the use of novel strategies, especially in patients who hold the highest potential for postoperative morbidity. In this paper, we will highlight the strategies and pitfalls associated with minimally invasive total coronary revascularization via left anterior minithoracotomy.
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23
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Moktan Lama PB, Khakural P, Sigdel S, Raj Bhatta M, Sah Teli R, Baral RK, Bhattarai A, Pradhan B, Koirala B. Del Nido Cardioplegia in Coronary Artery Bypass Grafting Surgery: A safe, efficacious and economic alternative to St. Thomas solution; an experience from a developing nation. Perfusion 2021; 36:470-475. [PMID: 33509043 DOI: 10.1177/0267659121991033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION del Nido cardioplegia is a newer solution getting popular worldwide, whereas in Nepal, St. Thomas cardioplegia solution is conventionally used. There is no national recommendation on cardioplegia solutions supported by evidences from Nepalese studies. This study aimed to evaluate and compare the efficacy of these solutions in Nepalese patients undergoing coronary artery bypass grafting. METHODS Patients undergoing coronary revascularization, from May 2018 to December 2019, were randomized into St. Thomas and del Nido groups based on the cardioplegia administered, with 45 patients in each group. Preoperative, intraoperative, and postoperative parameters and cost of cardioplegia preparation in the two groups were compared. RESULTS The cardiopulmonary bypass time (106.13 ± 24.65 minutes vs 107.62 ± 18.69 minutes, p = 0.02), aortic cross clamp time (66.22 ± 15.40 minutes vs 72.07 ± 12.23 minutes, p = 0.04), volume (1059.22 ± 100.30 ml vs 1526.67 ± 271.81 ml, p < 0.001) and number of cardioplegia doses (1.00 ± 0.00 vs 2.51 ± 0.66, p < 0.001) were significantly lower with del Nido cardioplegia. A lower CPK-MB at second post-operative (59.91 ± 31.62 vs 73.82 ± 37.25, p = 0.03) and a higher left ventricle ejection fraction at discharge (56.33 ± 8.94% vs 50.45 ± 8.55%, p < 0.001) was observed in del Nido group. There was one death in St. Thomas group. ICU and hospital stay were similar in both groups. St. Thomas solution was found to be costlier than del Nido solution (USD 5.40 ± 0.96 vs USD 3.50 ± 0.34, p < 0.001). CONCLUSION The del Nido cardioplegia was found to be efficacious, safe and more economical alternative to St. Thomas solution.
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Affiliation(s)
- Purna Bahadur Moktan Lama
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Prabhat Khakural
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Shailendra Sigdel
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Mahendra Raj Bhatta
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Rabindra Sah Teli
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Ravi Kumar Baral
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Anil Bhattarai
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Bishwas Pradhan
- Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Bhagawan Koirala
- Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
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24
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Misra S, Srinivasan A, Jena SS, Bellapukonda S. Myocardial Protection in Adult Cardiac Surgery With del Nido Versus Blood Cardioplegia: A Systematic Review and Meta-Analysis. Heart Lung Circ 2020; 30:642-655. [PMID: 33281072 DOI: 10.1016/j.hlc.2020.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/24/2020] [Accepted: 10/16/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Myocardial protection in adult cardiac surgery is commonly achieved with either multidose blood cardioplegia or single-dose del Nido crystalloid cardioplegia. AIM The aim of this systematic review and meta-analysis was to compare the outcomes of del Nido cardioplegia versus blood cardioplegia in adult cardiac surgery. METHOD All English-language articles were searched in MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar up to March 2020, to identify randomised control trials, prospective observational studies, and retrospective analyses (with or without propensity matching) reporting any or all of the primary and secondary endpoints. The primary endpoint was all-cause mortality. Secondary endpoints included cardiopulmonary bypass (CPB) and aortic cross-clamp (AoX) time; cardioplegia volume; need for defibrillation after AoX release; intraoperative glucose; postoperative myocardial enzyme release; postoperative left ventricular ejection fraction (LVEF); incidence of postoperative acute kidney injury (AKI), atrial fibrillation (AF), stroke, and low cardiac output syndrome (LCOS); postoperative blood transfusion; duration of mechanical ventilation; and length of intensive care unit (ICU) and hospital stay. RESULTS Twenty-nine (29) studies were included. There was no difference in the primary outcome of mortality between the two groups (odds ratio [OR], 1.18; 95% confidence interval [CI], 0.82-1.72 [p=0.37]). del Nido cardioplegia was associated with significantly shorter CPB (mean difference [MD], -7.42 minutes; 95% CI, -12.53 to -2.31 [p=0.004]) and AoX times (MD, -6.39 minutes; 95% CI, -10.30 to -2.48 [p=0.001]), and lower cardioplegia volumes. Significantly fewer patients required defibrillation after AoX release in the del Nido group. Intraoperative glucose homeostasis was better preserved in the del Nido group. Postoperative cardiac troponin T release and the number of patients needing transfusions were less in the del Nido group. No differences were seen in postoperative LVEF, or in the incidence of AKI, stroke, AF, and LCOS. Duration of mechanical ventilation, and length of ICU and hospital stay were similar. CONCLUSIONS Although this meta-analysis failed to find any mortality benefits with del Nido cardioplegia, significant benefits were seen in a number of intraoperative and postoperative variables. del Nido cardioplegia is a safe and favourable alternative to blood cardioplegia in adult cardiac surgery.
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Affiliation(s)
- Satyajeet Misra
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.
| | - Anand Srinivasan
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Sritam Swarup Jena
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Snigdha Bellapukonda
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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25
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Guim GS, Wah Hoon CG, Lim CA, Chay-Nancy HS, Li Ler AA, Lim QX, Jaafar NB, Lim C, Sazzad F, Kofidis T. Use of del Nido Cardioplegia for Adult Heart Surgery: How Long Is Not Too Long? THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2020; 52:272-278. [PMID: 33343029 PMCID: PMC7728503 DOI: 10.1182/ject-2000025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/06/2020] [Indexed: 11/20/2022]
Abstract
The most apparent practical advantage of del Nido cardioplegia (DNC) is that it allows the surgeon a longer arrest period before a subsequent dose is needed, as opposed to the conventional St. Thomas' cardioplegia solution where the recommended ischemic time is ∼15-20 minutes. In this study, we explored the incidence of arrhythmia after cross-clamp removal as a surrogate for a safe myocardial ischemic time with the use of DNC in adult heart surgery. A total of 113 patients who had undergone heart valve repair and/or replacement surgery at the National University Hospital, Singapore, were investigated. This single-center retrospective study was conducted on a population where DNC had been used for myocardial protection between January 2017 and April 2019. Cardioplegia ischemic time interval groups were not significant predictors of postoperative arrhythmia, defibrillation, and intraoperative intra-aortic balloon pump usage. Crude comparison of postoperative outcomes showed no significant differences in any other postoperative variables, including mortality and total hospital stay. From the results of the present study, it appears that there is no optimal ischemic time interval for the administration of DNC within a 120-minute time period. It is likely that DNC has a redosing interval of, and may provide adequate myocardial protection, for up to 120 minutes.
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Affiliation(s)
- Goh Si Guim
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Cindy Goh Wah Hoon
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Clara Anne Lim
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Huang Shoo Chay-Nancy
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Ashlynn Ai Li Ler
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Qi Xuan Lim
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Nurdiyana Binte Jaafar
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Cheryl Lim
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Faizus Sazzad
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Theo Kofidis
- Perfusion Services, Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore; School of Medicine, National University of Ireland, Galway, Ireland; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; and Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
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26
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Schutz A, Zhang Q, Bertapelle K, Beecher N, Long W, Lee VV, Pan W, Arcaro M, Ghanta R, Jimenez E, Ott DA, Loor G. Del Nido cardioplegia in coronary surgery: a propensity-matched analysis. Interact Cardiovasc Thorac Surg 2020; 30:699-705. [PMID: 32249892 DOI: 10.1093/icvts/ivaa010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/02/2020] [Accepted: 01/12/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Del Nido cardioplegia (DNC) has been shown to be safe in adults with normal coronary arteries who are undergoing valve surgery. This study compared the effects of DNC versus traditional blood-based cardioplegia on postoperative complications in patients who underwent coronary artery bypass grafting (CABG). METHODS A retrospective analysis was performed on 863 patients who underwent CABG with DNC (n = 420) or control cardioplegia (CC) (n = 443) between 2014 and 2017. The full cohort of DNC and CC recipients, as well as propensity score-matched pairs, was compared regarding preoperative risk variables and outcomes. RESULTS The DNC and CC groups showed no significant differences in mean cardiopulmonary bypass time (53.09 vs 52.10 min, P = 0.206) or aortic cross-clamp time (32.82 vs 33.28 min, P = 0.967). The groups also showed no difference in operative mortality (2.1% vs 2.5%, P = 0.734); however, DNC use resulted in lower rates of overall infections (1.7% vs 4.3%, P = 0.024), total sternal infections (0.9% vs 3.2%, P = 0.023), postoperative atrial fibrillation (23.8% vs 30.7%, P = 0.023) and postoperative ventricular tachycardia (0.5% vs 3.4%, P = 0.002). A propensity-matching analysis (n = 335 pairs) showed similar statistically significant decreases with DNC. CONCLUSIONS In this large cohort of CABG patients, DNC was shown as a safe alternative to CC and was associated with lower postoperative dysrhythmia and infection rates. These findings show that DNC is safe and effective in patients whose operative interventions may require only single-dosing cardioplegia; its use in longer cases should be further explored given its low complication rate.
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Affiliation(s)
- Alexander Schutz
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | - Qianzi Zhang
- Surgical Research Core, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Nicholas Beecher
- School of Perfusion Technology, Texas Heart Institute, Houston, TX, USA
| | - William Long
- School of Perfusion Technology, Texas Heart Institute, Houston, TX, USA
| | - Vei-Vei Lee
- Department of Biostatistics and Epidemiology, Texas Heart Institute, Houston, TX, USA
| | - Wei Pan
- Department of Cardiovascular Anesthesiology, Baylor College of Medicine/Texas Heart Institute, Houston, TX, USA
| | - Michael Arcaro
- School of Perfusion Technology, Texas Heart Institute, Houston, TX, USA
| | - Ravi Ghanta
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | - Ernesto Jimenez
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | - David A Ott
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | - Gabriel Loor
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
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27
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Haranal M, Chin HC, Sivalingam S, Raja N, Mohammad Shaffie MS, Namasiwayam TK, Fadleen M, Fakhri N. Safety and Effectiveness of Del Nido Cardioplegia in Comparison to Blood-Based St. Thomas Cardioplegia in Congenital Heart Surgeries: A Prospective Randomized Controlled Study. World J Pediatr Congenit Heart Surg 2020; 11:720-726. [DOI: 10.1177/2150135120936119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: To compare the safety and effectiveness of del Nido cardioplegia with blood-based St Thomas Hospital (BSTH) cardioplegia in myocardial protection in congenital heart surgery. Methods: It is a prospective, open-labeled, randomized controlled study conducted at National Heart Institute, Kuala Lumpur from July 2018 to July 2019. All patients with simple and complex congenital heart diseases (CHD) with good left ventricular function (left ventricular ejection fraction [LVEF] >50%) were included while those with LVEF <50% were excluded. A total of 100 patients were randomized into two groups of 50 each receiving either del Nido or BSTH cardioplegia. Primary end points were the spontaneous return of activity following aortic cross-clamp release and ventricular function between two groups. Secondary end point was myocardial injury as assessed by troponin T levels. Results: Cardiopulmonary bypass and aortic cross-clamp time, return of spontaneous cardiac activity following the aortic cross-clamp release, the duration of mechanical ventilation, and intensive care unit stay were comparable between two groups. Statistically significant difference was seen in the amount and number of cardioplegia doses delivered ( P < .001). The hemodilution was significantly less in the del Nido complex CHD group compared to BSTH cardioplegia ( P = .001) but no difference in blood usage ( P = .36). The myocardial injury was lesser (lower troponin T release) with del Nido compared to BSTH cardioplegia ( P = .6). Conclusion: Our study showed that both del Nido and BSTH cardioplegia are comparable in terms of myocardial protection. However, single, less frequent, and lesser volume of del Nido cardioplegia makes it more suitable for complex repair.
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Affiliation(s)
- Maruti Haranal
- Department of Pediatric Cardiac Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Hew Chee Chin
- Department of Pediatric Cardiac Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Sivakumar Sivalingam
- Department of Pediatric Cardiac Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Natesan Raja
- Department of Cardiac Anesthesia, National Heart Institute, Kuala Lumpur, Malaysia
| | | | | | - Mohammad Fadleen
- Department of Perfusion Sciences, National Heart Institute, Kuala Lumpur, Malaysia
| | - Nurul Fakhri
- Department of Clinical Research, National Heart Institute, Kuala Lumpur, Malaysia
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28
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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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29
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George G, Varsha AV, Philip MA, Vithayathil R, Srinivasan D, Sneha Princy FX, Sahajanandan R. Myocardial protection in cardiac surgery: Del Nido versus blood cardioplegia. Ann Card Anaesth 2020; 23:477-484. [PMID: 33109807 PMCID: PMC7879885 DOI: 10.4103/aca.aca_153_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objectives: del Nido cardioplegia which was traditionally used for myocardial protection in pediatric congenital heart surgery is now being extensively utilized in adult cardiac surgery. The aim of this study was to compare the safety and efficacy of del Nido cardioplegia (DNC) with blood cardioplegia (BC). Materials and Methods: This is a historical cohort study using secondary data. Two hundred and eighty six patients who underwent coronary artery bypass graft (CABG) or valve surgery were included. They were divided into 2 matched cohorts of which 143 patients received BC and 143 patients received DNC. Results: There was no difference in cardiopulmonary bypass time (P = 0.516) and clamp time (P = 0.650) between the groups. The redosing of cardioplegia was significantly less for DNC (1.13 vs. 2.35, P = <0.001). The post bypass hemoglobin was higher for DNC (9.1 vs. 8.7, P = 0.011). The intraoperative and postoperative blood transfusion was comparable (P = 0.344) (P = 0.40). The incidence of clamp release ventricular fibrillation (P = 0.207) was similar. The creatine kinase-MB isotype levels for the CABG patients were comparable on all 3 days (P = 0.104), (P = 0.106), and (P = 0.158). The postoperative left ventricle ejection fraction was lesser but within normal range in the DNC group (53.4 vs. 56.0, P = <0.001). The duration of ventilation (P = 0.186), ICU days (P = 0.931), and postoperative complications (P = 0.354) were comparable. There was no 30-day mortality or postoperative myocardial infarction in both the groups. Conclusion: DNC provides equivalent myocardial protection, efficacy, and surgical workflow and had comparable clinical outcomes to that of BC. This study shows that DNC is a safe alternate to BC in CABG and valve surgeries.
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Affiliation(s)
- Gladdy George
- Department of Anesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - A V Varsha
- Department of Cardiothoracic Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Madhu Andrew Philip
- Department of Cardiothoracic Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Reshma Vithayathil
- Department of Anesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Dharini Srinivasan
- Department of Cardiothoracic Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - F X Sneha Princy
- Department of Biostatistics, Christian Medical College, Bagayam, Vellore, Tamil Nadu, India
| | - Raj Sahajanandan
- Department of Anesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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30
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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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Evaluating Changes in del Nido Cardioplegia Practices in Adult Cardiac Surgery. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2020; 52:173-181. [PMID: 32981954 DOI: 10.1182/ject-2000014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/16/2020] [Indexed: 11/20/2022]
Abstract
There has been a rapid adoption of the use of del Nido cardioplegia (DC) among adults undergoing cardiac surgery. We leveraged a multicenter database to evaluate differences over time in the choice and impact of cardioplegia type (DC vs. blood) among patients undergoing cardiac surgery. We evaluated 26,373 patients undergoing non-emergent coronary artery bypass and/or valve surgery between 2014-2015 (early period) and 2017-2018 (late period) at 31 centers. DC was compared with blood-based cardioplegia (BC: 1:1, 2:1, 4:1, 8:1, and variable ratio). We evaluated whether treatment choice differed across prespecified patient characteristics, procedure type, and perfusion practices by time period. We evaluated increased DC use with clinical outcomes (major morbidity and mortality, prolonged intubation, and renal failure), after adjusting for baseline characteristics, procedure type, center, and year. DC use increased from 19.6% in 2014-2015 to 41.5% in 2017-2018, p < .001. Increased DC use occurred among coronary artery bypass grafting (CABG), valve, and CABG + valve procedures, all p < .001. Differences in median procedural duration increased over time (DC vs. BC): 1) bypass duration was 11.0 minutes shorter with DC in the early period and 27.0 minutes shorter in the late period, and 2) cross-clamp duration was 7.0 minutes shorter with DC in the early period and 17.0 minutes shorter in the late period, all p < .001. There were no statistical differences in adjusted odds of major morbidity and mortality (odds ratio [OR]adj: 1.01), prolonged intubation (ORadj: .99), or renal failure (ORadj: .80) by DC use (p > .05). In this large multicenter experience, DC use increased over time and was associated with reduced bypass and ischemic time absent any significant differences in adjusted outcomes.
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Pragliola C, Hassan E, Ismail H, Al Otaibi K, Alfonso JJ, Algarni KD. del Nido Cardioplegia in Adult Patients: A Propensity-Matched Study of 102 Consecutive Patients. Heart Lung Circ 2020; 29:1405-1411. [DOI: 10.1016/j.hlc.2019.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/30/2019] [Accepted: 08/19/2019] [Indexed: 10/25/2022]
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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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Chen H, Wang L, Wan L, Xiao L, Chen X. Use of del Nido cardioplegia in acute aortic dissection surgery. Perfusion 2020; 36:233-238. [PMID: 32693687 DOI: 10.1177/0267659120938528] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Del Nido cardioplegia solution provides a depolarized hyperkalemic arrest lasting up to 60 minutes. Single-dose del Nido cardioplegia solution may offer an alternative myocardial protection strategy to conventional whole blood cardioplegia following acute aortic dissection surgery. Methods: We retrospectively reviewed 122 consecutive patients with acute aortic dissection undergoing arch reconstruction surgery procedure with cardioplegia arrest from January 2017 to December 2019. Patients exclusively received with whole blood cardioplegia (n = 60, January 2017–December 2018) or del Nido cardioplegia (n = 62, January 2018–December 2019). Preoperative and postoperative data were retrospectively reviewed. Results: No significant difference between two groups in mortality (4/60 vs 3/62, p = 0.964), cardiopulmonary bypass time (168.0 ± 10.5 minute vs 165.0 ± 12.5 minute, p = 0.154), aortic cross-clamp time (91.8 ± 9.0 minute vs 93.2 ± 9.5 minute, p = 0.405), selective antegrade cerebral perfusion time (21.8 ± 5.0 minute vs 22.4 ± 4.7 minute, p = 0.496) and postoperative vasoactive inotropic score (34.8 ± 1.9 vs 35.2 ± 2.1, p = 0.272), neurological complications rate (8/60 vs 12/62, p = 0.523), renal insufficiency rate (5/60 vs 7/62, p = 0.807) and the troponin T level (304.8 ± 111.3 vs 315.0 ± 94.9, p = 0.588), respectively. Mean volume of crystalloid was significantly higher in the del Nido group compared to the whole blood cardioplegia group (1010.2 ± 20.3 mL vs 300.0 ± 19.6 mL, p < 0.001). Patients requiring defibrillation was 7/62 vs 28/60 (p < 0.001), with statistical difference in both groups. Conclusion: Short-term outcomes in acute aortic dissection surgery using del Nido cardioplegia solution were acceptable and comparable to conventional multi-dose whole blood cardioplegia. Del Nido cardioplegia technique is associated with lower defibrillations rate and requires a reduced frequency of infusions that results in longer durations between infusions and may be a feasible alternative to conventional whole blood cardioplegia solution in acute aortic dissection surgery.
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Affiliation(s)
- HongWei Chen
- Department of Thoracic and Cardiovascular Surgery, The First Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Lei Wang
- Department of Thoracic and Cardiovascular Surgery, The First Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - LinLin Wan
- Department of Thoracic and Cardiovascular Surgery, The First Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - LiQiong Xiao
- Department of Thoracic and Cardiovascular Surgery, The First Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, The First Hospital Affiliated to Nanjing Medical University, Nanjing, 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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Zakkar M, Bruno VD. Commentary: Cardioplegia in complex root surgery for adults: Many solutions, but does it really matter? J Thorac Cardiovasc Surg 2020; 162:526-527. [PMID: 32127204 DOI: 10.1016/j.jtcvs.2020.01.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mustafa Zakkar
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Vito Domenico Bruno
- Translational Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
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Commentary: The role of del Nido cardioplegia in adult cardiac surgery: The jury is still out. J Thorac Cardiovasc Surg 2020; 162:523-525. [PMID: 32127202 DOI: 10.1016/j.jtcvs.2020.01.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/23/2022]
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Timek TA, Beute T, Robinson JA, Zalizadeh D, Mater R, Parker JL, Lypka M, Willekes CL. Del Nido cardioplegia in isolated adult coronary artery bypass surgery. J Thorac Cardiovasc Surg 2019; 160:1479-1485.e5. [PMID: 31706553 DOI: 10.1016/j.jtcvs.2019.09.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 08/14/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Del Nido cardioplegia (DC) offers prolonged single-dose myocardial protection in pediatric cardiac surgery. We set out to evaluate the efficacy of DC in adult patients undergoing isolated coronary artery bypass grafting (CABG). METHODS From January 2012 to October 2017, 851 consecutive isolated CABG surgeries were performed by 2 study surgeons at our center with blood cardioplegia (BC, n = 350), used from January 2012 to April 2014, and DC (n = 501), used from May 2014 to October 2017. Propensity matching was used to yield 325 well-matched pairs. Clinical data were extracted from our local Society of Thoracic Surgeons database and mortality data from the Michigan State Social Security Death Index. RESULTS Single-dose administration was used in 83% (417/501) of patients receiving DC. In propensity-matched groups, postoperative median troponin T levels (0.28 [0.16-0.59] ng/mL vs 0.46 [0.27-0.81] ng/mL; P < .01) were lower for patients receiving DC, and no difference in ejection fraction on postoperative echocardiography was observed (54 ± 12% and 53 ± 13% for BC and DC, respectively; P = .36). Perioperative outcomes were similar except for greater rate of atrial fibrillation (33% vs 23%; P = .01) in the DC group. Subgroup analyses revealed equivalent myocardial protection and clinical outcomes in patients with age ≥75 years, left ventricular ejection fraction ≤35%, left main disease, or Society of Thoracic Surgeons score ≥2.5%. Four-year survival did not differ between patients undergoing BC or DC. CONCLUSIONS The current study revealed noninferior myocardial protection and clinical outcomes with DC versus BC in both routine and greater-risk patients undergoing isolated CABG. DC demonstrated the feasibility of single-dose administration for isolated CABG surgery. Larger randomized studies are needed to further explore the safety and efficacy of DC in adult cardiac surgery with longer crossclamp times.
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Affiliation(s)
- Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich.
| | - Tyler Beute
- Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Justin A Robinson
- Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Daniel Zalizadeh
- Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Regina Mater
- Michigan State University College of Human Medicine, Grand Rapids, Mich
| | | | - Matthew Lypka
- Office of Research, Spectrum Health, Grand Rapids, Mich
| | - Charles L Willekes
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich
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Gambardella I, Gaudino MFL, Antoniou GA, Rahouma M, Worku B, Tranbaugh RF, Nappi F, Girardi LN. Single- versus multidose cardioplegia in adult cardiac surgery patients: A meta-analysis. J Thorac Cardiovasc Surg 2019; 160:1195-1202.e12. [PMID: 31590948 DOI: 10.1016/j.jtcvs.2019.07.109] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/11/2019] [Accepted: 07/26/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare outcomes of single (intervention group: del Nido [DN], and histamine-tryptophan-ketoglutarate) versus multidose (control group) cardioplegia in the adult cardiac surgery patients. METHODS Medical search engines were interrogated to identify relevant randomized controlled trials and propensity-score matched cohorts. Meta-analysis was conducted for primary (in-hospital/30-day mortality) and secondary (ischemic and cardiopulmonary bypass [CPB] times, reperfusion fibrillation, peak of cardiac enzymes, myocardial infarction) endpoints. Subgroup analyses were conducted for study design and type of intervention, and meta-regression for primary outcome included type of surgery and left ventricular ejection fraction as moderators. RESULTS Ten randomized controlled trials and 13 propensity-score matched cohorts were included, reporting on 5516 patients. Estimates are expressed as (parameter value [OR, odds ratio; MD, mean difference; SMD, standardized mean difference]/unit of measure [95% confidence interval], P value). DN reduced ischemic time (MD, -7.18 minutes [-12.52 to -1.84], P < .01), CPB time (MD, -10.44 minutes [-18.99 to -1.88], P .01), reperfusion fibrillation (OR, 0.16 [0.05-0.54], P < .01), and cardiac enzymes (SMD -0.17 [-0.29, 0.05], P < .01) compared with multidose cardioplegia. None of these beneficial effects were reproduced by histamine-tryptophan-ketoglutarate, which instead increased CPB time (MD, 2.04 minutes [0.73-3.37], P < .01) and reperfusion fibrillation (OR, 1.80 [1.20-2.70], P < .01). There was no difference in mortality and myocardial infarction between single and multidose, independently of type of surgery or left ventricular ejection fraction. CONCLUSIONS DN decreases operative times, reperfusion fibrillation, and surge of cardiac enzymes compared with multidose cardioplegia.
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Affiliation(s)
- Ivancarmine Gambardella
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Medical Center, New York, NY; Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Medical Center, New York, NY
| | - George A Antoniou
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY; Department of Vascular & Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Mohamad Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Medical Center, New York, NY
| | - Berhane Worku
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Medical Center, New York, NY; Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Robert F Tranbaugh
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Medical Center, New York, NY; Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Francesco Nappi
- Cardiac Surgery Center, Cardiologique du Nord de Saint-Denis, Paris, France
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian Medical Center, New York, NY
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Kantathut N, Cherntanomwong P, Khajarern S, Leelayana P. Lactated Ringer's as a Base Solution for del Nido Cardioplegia. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2019; 51:153-159. [PMID: 31548737 PMCID: PMC6749166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/02/2019] [Indexed: 06/10/2023]
Abstract
Unavailability of Plasma-Lyte A precludes the utility of traditional del Nido cardioplegia in many countries. This observational study aimed to evaluate myocardial preservation and clinical outcomes when using lactated Ringer's solution as the base solution for del Nido cardioplegia as compared with our institute's standard blood cardioplegia strategy. Eighty-nine adult patients underwent cardiac surgery for acquired heart disease from February 2017 to November 2017 either with del Nido cardioplegia (n = 44) or blood cardioplegia (n = 45). Clinical data and outcomes were compared. Patient characteristics were similar between groups. Troponin T release was lower in the del Nido group on postoperative day 1 (.632 [.437, .907] vs. .827 [.599, 1.388] ng/mL; p = .009) and day 2 (.363 [.250, .451] vs. .549 [.340, .897] ng/mL; p = .002). The del Nido group exhibited lower total volume of cardioplegia administered (1,075 [1,000, 1,250] vs. 3,400 [2,700, 3,750] mL; p < .0001), fewer doses (1.6 ± .7 vs. 4.6 ± 1.3; p < .0001), and a decreased incidence of ventricular fibrillation after aortic cross-clamp removal (9.09 vs. 31.11%; p = .01). The del Nido group had shorter intensive care unit stays (2 [1, 2] vs. 3 [2, 4] days; p < .0001), hospital stays (7 [6, 10] vs. 9 [7, 10] days; p = .0002), less vasopressor and inotropic support (1 [1, 1] vs. 1 [1, 2] days; p = .0001), and lower incidence of postoperative atrial fibrillation/flutter (25 vs. 46.7%; p = .033). No mortality occurred and clinical outcomes were similar. The use of traditional del Nido cardioplegia ingredients added to lactated Ringer's as the base solution provided either similar or superior myocardial protection than our blood cardioplegia strategy depending on the outcome measure analyzed. The use of lactated Ringer's as a base solution may be an option for centers that do not have access to Plasma-Lyte. Further investigation and follow-up are warranted after this observational study.
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Affiliation(s)
- Narongrit Kantathut
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piya Cherntanomwong
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Siam Khajarern
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Parinya Leelayana
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Ghimire A, Bisset ES, Howlett SE. Ischemia and reperfusion injury following cardioplegic arrest is attenuated by age and testosterone deficiency in male but not female mice. Biol Sex Differ 2019; 10:42. [PMID: 31443710 PMCID: PMC6708213 DOI: 10.1186/s13293-019-0256-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/12/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cardiovascular disease increases with age in both sexes. Treatment can require cardiac surgery, where the hearts are pre-treated with protective cardioplegic solution before ischemia and reperfusion (I/R). While endogenous estrogen is beneficial in I/R, whether testosterone is involved is uncertain and whether age modifies responses to I/R is unclear. We investigated sex- and age-specific differences in I/R injury in the hearts pre-treated with clinically relevant cardioplegic solution. METHODS The hearts were isolated from young (6-9 months) and old (20-28 months) mice of both sexes and perfused (Langendorff) with Krebs-Henseleit buffer (15 min, 37 °C), followed by St. Thomas' two cardioplegia (6 min, 6-7 °C), global ischemia (90 min, 23-24 °C), and reperfusion (30 min, 37 °C). The hearts were perfused with triphenyltetrazolium chloride to quantify infarct area. Testosterone's role was investigated in gonadectomized (GDX, 6-9 months) male mice; serum testosterone and estradiol were measured with ELISA assays. RESULTS Left ventricular developed pressure (LVDP) recovered to 67.3 ± 7.4% in the old compared to 21.8 ± 9.2% in the young male hearts (p < 0.05). Similar results were seen for rates of pressure development (+dP/dt) and decay (-dP/dt). Infarct areas were smaller in the old male hearts (16.6 ± 1.6%) than in the younger hearts (55.8 ± 1.2%, p < 0.05). By contrast, the hearts from young and old females exhibited a similar post-ischemic functional recovery and no age-dependent difference in infarcts. There was a sex difference in the young group, where ventricular function (LVDP, +dP/dt, -dP/dt) recovered better and infarcts were smaller in females than males. Estradiol levels were highest in young females. Testosterone was high in young males but low in females and old males, which suggested beneficial effects of low testosterone. Indeed, the hearts from GDX males exhibited much better recovery of LVDP in reperfusion than that from intact males (values were 64.4 ± 7.5 % vs. 21.8 ± 9.2%; p < 0.05). The GDX hearts also had smaller infarcts than the hearts from intact males (p < 0.05). CONCLUSIONS Although age had no effect on susceptibility to I/R injury after cardioplegic arrest in females, it actually protected against injury in older males. Our findings indicate that low testosterone may be protective against I/R injury following cardioplegic arrest in older males.
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Affiliation(s)
- Anjali Ghimire
- Department of Pharmacology, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, PO Box 15000, Halifax, Nova Scotia B3H 4R2 Canada
| | - Elise S. Bisset
- Department of Pharmacology, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, PO Box 15000, Halifax, Nova Scotia B3H 4R2 Canada
| | - Susan E. Howlett
- Department of Pharmacology, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, PO Box 15000, Halifax, Nova Scotia B3H 4R2 Canada
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia Canada
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Nakao M, Morita K, Shinohara G, Kunihara T. Excellent Restoration of Left Ventricular Compliance After Prolonged Del Nido Single-Dose Cardioplegia in an In Vivo Piglet Model. Semin Thorac Cardiovasc Surg 2019; 32:475-483. [PMID: 31401181 DOI: 10.1053/j.semtcvs.2019.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022]
Abstract
Del Nido cardioplegia (DN) is used in congenital heart surgery and recently in adults, a single dose has been administered. However, the tolerable ischemic time has not been established. The objective is to evaluate the left ventricular (LV) function recovery and accompanying biochemical and histologic markers to clarify the tolerable ischemic time in an in vivo cardiopulmonary bypass (CPB) piglet model. Twenty-one piglets were subjected to either 90 minutes (with or without topical cooling; TC) or 120 minutes (with TC) of global ischemia induced by single-dose DN, while the other 7 served as the control group (CPB only). The CPB temperature was established with a perfusion temperature of 30°C. The LV function recovery was assessed by the percent change in end-systolic elastance (Ees) and the end-diastolic pressure-volume relationship (EDPVR). Creatine kinase-MB (CK-MB) levels and the mitochondrial score were also assessed. LV contractility assessed by %Ees after 90 and 120 minutes of ischemia (89.3 ± 20.6% and 57.9 ± 17.8%) was lower compared with the control group (122.6 ± 35.8%, P = 0.001). Conversely, LV compliance assessed by %EDPVR was preserved in both groups (102.7 ± 28.2% and 88.5 ± 24.0%), which was comparable to the control group (105.8 ± 36.9%, P = 0.531). There was no change in LV contractility after 90 minutes of ischemia with or without TC (89.3 ± 20.6% or 84.8 ± 16.2%, P = 0.657), whereas LV compliance was lower but not statistically different without TC (102.7 ± 28.2% vs 78.0 ± 38.9%). CK-MB and the mitochondrial score were equivalent between all groups. The proposed single-dose ischemic time for redosing is 90 minutes using TC.
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Affiliation(s)
- Mitsutaka Nakao
- Department of Cardiac Surgery, the Jikei University School of Medicine, Tokyo, Japan.
| | - Kiyozo Morita
- Department of Cardiac Surgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Gen Shinohara
- Department of Cardiac Surgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Kunihara
- Department of Cardiac Surgery, the Jikei University School of Medicine, Tokyo, Japan
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An KR, Rahman IA, Tam DY, Ad N, Verma S, Fremes SE, Latter DA, Yanagawa B. A Systematic Review and Meta-Analysis of del Nido Versus Conventional Cardioplegia in Adult Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:385-393. [PMID: 31347414 DOI: 10.1177/1556984519863718] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Del Nido cardioplegia (DC) has been used extensively in pediatric cardiac surgery but the efficacy and safety in adults remains uncertain. Our objective was to perform a systematic review and meta-analysis comparing DC and blood cardioplegia (BC) in our primary endpoint of 30-day or in-hospital mortality as well as other efficacy and safety endpoints. METHODS Both MEDLINE and EMBASE were searched from 1996 to 2017 for studies comparing DC and BC. Data were extracted by 2 independent investigators and aggregated in a random effects model. RESULTS One randomized controlled trial (n = 89), 7 adjusted (n = 1,104), and 5 unadjusted observational studies (n = 717) were included. There was no difference in in-hospital mortality between DC and BC (relative risk:0.67, 95% confidence interval [CI]: 0.22, 2.07; P = 0.49). DC reduced cardioplegia volume requirements (mean difference [MD]:-1.1 L, 95% CI, -1.6, -0.6; P < 0.0001), aortic cross-clamp time (MD: -8 minutes, 95% CI, -12, -3; P = 0.0004), and cardiopulmonary bypass (CPB) times (MD: -8 minutes, 95% CI, -14, -3; P = 0.03). DC reduced troponin release (standardized MD: -0.3, 95% CI, -0.5, -0.1; P = 0.001). In-hospital outcomes of stroke, atrial fibrillation, acute kidney injury/dialysis, low cardiac output state, blood transfusion, reoperation rate, postoperative left ventricular EF, intensive care unit length of stay (LOS), and in-hospital LOS were comparable between groups. CONCLUSIONS DC is a safe alternative to BC in routine adult cardiac surgery. Its use is associated with reduction in CPB and aortic cross-clamp times and may potentially offer improved myocardial protection.
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Affiliation(s)
- Kevin R An
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Ishtiaq A Rahman
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Derrick Y Tam
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Niv Ad
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - David A Latter
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Ontario, Canada
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Sanetra K, Gerber W, Shrestha R, Domaradzki W, Krzych Ł, Zembala M, Cisowski M. The del Nido versus cold blood cardioplegia in aortic valve replacement: A randomized trial. J Thorac Cardiovasc Surg 2019; 159:2275-2283.e1. [PMID: 31358336 DOI: 10.1016/j.jtcvs.2019.05.083] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 05/02/2019] [Accepted: 05/17/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the cardioprotective efficacy of a solution that requires only a single infusion at the start of the ischemic duration versus a solution that requires multiple infusions. METHODS Aortic valve replacement was performed for 150 patients, who were randomized into the del Nido (DN) cardioplegia group or the cold blood (CB) cardioplegia group. The DN cardioplegia was delivered every 90 minutes and the CB cardioplegia was delivered every 20 to 30 minutes, or whenever cardiac activity was observed. The primary endpoints were electrical cardiac activity during crossclamp, ventricular fibrillation during reperfusion, and postoperative troponin and creatine kinase (CK-MB isoenzyme) at 24 and 48 hours. RESULTS Electrical activity during crossclamp occurred in 29 (39.7%) patients in the DN group versus 34 (45.3%) patients in the CB group (adjusted P = 1.0). The number of procedures with ventricular fibrillation after removing the crossclamp was 41 (54.7%) in the CB group versus 17 (22.7%) in the DN group (adjusted P = .001; relative risk, 2.41). Troponin values appeared to be lower in the DN group (median, 223.10; interquartile range, 168.35-364.77 pg/mL vs 285.5; 196.20-419.45 pg/mL at 24 hours and 159.60; 125.42-217.20 pg/mL vs 201.60; 160.62-268.45 pg/mL at 48 hours) and CK-MB (median, 14.94; interquartile range, 12.16-20.39 ng/mL vs 17.43; 13.66-22.43 ng/mL at 24 hours and 6.19; 4.41-7.63 ng/mL vs 7.38; 4.74-10.20 ng/mL at 48 hours), but no significance was found. CONCLUSIONS The del Nido cardioplegia protocol is an acceptable alternative for cold blood cardioplegia in patients undergoing aortic valve replacement.
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Affiliation(s)
- Krzysztof Sanetra
- 1st Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland; Center for Cardiovascular Research and Development, American Heart of Poland, Bielsko-Biała, Poland.
| | - Witold Gerber
- 1st Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland; Center for Cardiovascular Research and Development, American Heart of Poland, Bielsko-Biała, Poland
| | - Rajesh Shrestha
- 1st Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland; Center for Cardiovascular Research and Development, American Heart of Poland, Bielsko-Biała, Poland
| | - Wojciech Domaradzki
- 1st Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland; Center for Cardiovascular Research and Development, American Heart of Poland, Bielsko-Biała, Poland
| | - Łukasz Krzych
- Department of Anesthesiology and Intensive Therapy, Medical University of Silesia, Katowice, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Zabrze, Poland; Medical University of Silesia, Katowice, Poland
| | - Marek Cisowski
- 1st Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland; Center for Cardiovascular Research and Development, American Heart of Poland, Bielsko-Biała, Poland; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Zabrze, Poland; Medical University of Silesia, Katowice, Poland
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Luo H, Qi X, Shi H, Zhao H, Liu C, Chen H, Peng R, Yu Z, Hu K, Wang C, Li X. Single-dose del Nido cardioplegia used in adult minimally invasive valve surgery. J Thorac Dis 2019; 11:2373-2382. [PMID: 31372274 DOI: 10.21037/jtd.2019.05.78] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To analyze the protective effect of single-dose del Nido cardioplegia (DNC) in adult minimally invasive valve surgery. Methods From January to December 2017, 165 consecutive adult patients who underwent minimally invasive valve surgery by the same team of surgeons were divided into two cohorts based on the type of cardioplegia administered during surgery: (I) single-dose DNC (DNC group (n=76, male 41, female 35) used in patients from May to December, 2017 and (II) intermittent standard 4:1 blood cardioplegia based on St.Thomas solution (SBC group, n=89, male 45, female 44) used in patients from January to April, 2017. Preoperative baseline demographics, preoperative comorbidities, operative variables, postoperative complications, and patient outcomes were collected and compared between the two groups. Results Preoperative characteristics were shown to be similar between the two groups before and after propensity matching. Patients in the DNC group required a significantly lower volume of cardioplegia. The volume of ultrafiltration in the DNC group was substantially higher than that in the SBC group. The spontaneous return of heartbeat rate in the DNC group was considerably higher than that in the SBC group (97.0% vs. 78.8%, P=0.006). The Euroscore II in the DNC group was markedly lower than that in the SBC group (2.00 vs. 3.00, P<0.05). The level of blood urea nitrogen (BUN) in the DNC group was significantly lower than that in the SBC group (6.20 vs. 6.95, P<0.05). There were no differences in surgery procedure, cross-clamp time, bypass time, Apache score, troponin T (cTnT), brain natriuretic peptide (BNP), liver and renal function, postoperative complications or patient outcomes between two groups. Regression analysis showed that cTnT increased with the prolongation of myocardial ischemia time, and was closely related to the type of operation, but had no significant correlation with the type of cardioplegia. Conclusions In our initial experience, single-dose DNC in adult minimally invasive valve surgery in which the cross-clamp time was mostly less than 90 min, achieved equivalent myocardial protection and clinical outcomes when compared with standard whole blood cardioplegia. In addition, single-dose DNC made the minimally invasive valve surgery procedure progress in a smoother and more convenient fashion.
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Affiliation(s)
- Haiyan Luo
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaomin Qi
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hui Shi
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hui Zhao
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chaoqi Liu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hongsong Chen
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Runsheng Peng
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhangsheng Yu
- Department of Bioinformatics and Biostatistics, SJTU-Yale Joint Center for Biostatistics, Jiao Tong University, Shanghai 200240, China
| | - Kejian Hu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xin Li
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Gorgy A, Shore-Lesserson L. Del Nido Cardioplegia Should Be Used in All Adults Undergoing Cardiac Surgery: Con. J Cardiothorac Vasc Anesth 2019; 33:1791-1794. [DOI: 10.1053/j.jvca.2019.01.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/11/2022]
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49
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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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50
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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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