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Lee S, Jung JC, Chang HW, Lee JH, Kim DJ, Kim JS, Lim C. Comparative analysis of del Nido cardioplegia versus blood cardioplegia in isolate coronary artery bypass grafting. J Cardiothorac Surg 2024; 19:438. [PMID: 39003452 PMCID: PMC11245796 DOI: 10.1186/s13019-024-02853-1] [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: 03/04/2024] [Accepted: 06/14/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND This study examined the efficacy of del Nido cardioplegia compared with traditional blood cardioplegia in adult cardiac surgery for isolated coronary artery bypass grafting by evaluating the early postoperative outcomes. METHODS A total of 119 patients who underwent isolated conventional coronary artery bypass grafting were enrolled and divided into two groups (del Nido cardioplegia group [n = 36] and blood cardioplegia group [n = 50]) based on the type of cardioplegia used. This study compared the preoperative characteristics, intraoperative data, and early postoperative outcomes. Further subgroup analyses were conducted for high-risk patient groups. RESULTS The 30-day mortality and morbidity rates were not significantly different between groups. The del Nido cardioplegia group exhibited advantageous myocardial protection outcomes, demonstrated by a significantly smaller rise in Troponin I levels post-surgery (2.8 [-0.4; 4.2] vs. 4.5 [2.9; 7.4] ng/mL, p = 0.004) and fewer defibrillation attempts during weaning off of cardiopulmonary bypass (0.0 ± 0.2 vs. 0.4 ± 1.1 times, p = 0.011) when compared to the blood cardioplegia group. Additionally, the del Nido group achieved a reduction in surgery duration, as evidenced by the reduced aortic cross-clamping time (64.0 [55.5; 75.5] vs. 77.5 [65.0; 91.0] min, p = 0.001) and total operative time (287.5 [270.0; 305.0] vs. 315.0 [285.0; 365.0] min, p = 0.008). Subgroup analyses consistently demonstrated that the del Nido cardioplegia group had a significantly smaller postoperative increase in Troponin I levels across all subgroups (p < 0.05). CONCLUSIONS del Nido cardioplegia provided myocardial protection and favorable early postoperative outcomes compared to blood cardioplegia, making it a viable option for conventional coronary artery bypass grafting. Establishing a consensus on the protocol for Del Nido cardioplegia administration in adult surgeries is needed.
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Affiliation(s)
- Soojin Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Joon Chul Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Hyoung Woo Chang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Jae Hang Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Dong Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
| | - Jun Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea.
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Republic of Korea
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Malinowski M, Solarewicz M, Farley R, Salcido JR, Bush J, MacDoughall B, Bromberg-White J, Timek TA. Myocardial protection using single dose del Nido Cardioplegia with and without topical cooling. Perfusion 2024; 39:766-775. [PMID: 36842962 DOI: 10.1177/02676591231159507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Del Nido cardioplegia (DN) is gaining acceptance in adult cardiac surgery but there is paucity of experimental data regarding its efficacy. We set out to assess the safety and efficacy of single-dose DN with and without topical cooling (TC) versus multi-dose blood cardioplegia (BC). METHODS Thirty-two healthy adult sheep had pressure-volume (PV) catheters placed in the left (LV) and right (RV) ventricle. Animals were assigned to receive cold (4°C) antegrade solution for a 60-min arrest using: (1) multi-dose (every 20 min) BC with TC (n = 11), (2) single-dose DN with TC (DN-C, n = 10), or (3) single-dose DN without TC (DN-H, n = 11). LV and RV PV-derived indexes, epicardial echocardiographic strains, and blood samples were acquired before CPB and at 1, 2, and 3 h of reperfusion. Dobutamine bolus (2.5 μg) was given after 3 h to test for myocardial reserve. RESULTS Time to rhythm restoration was shortest (54 ± 29 s, 118 ± 167 s, and 172 ± 170 s for DN-H, DN-C, and BC, respectively; p = 0.024) and number of shocks lowest (1.7 ± 1.8, 3.6 ± 2.8, and 5.6 ± 4.6 for DN-H, DN-C, and BC, respectively; p = 0.020) in DN-H group. Hemodynamic, load-independent myocardial function, echocardiographic, and metabolic data revealed only slight differences between groups. Troponin I levels did not differ between groups. With dobutamine, preload-recruitable stroke work of both LV (136 ± 50%, 131 ± 31%, 142 ± 58% for BC, DN-C and DN-H, respectively; p = 0.993) and RV (161 ± 67%, 185 ± 45%, 166 ± 75% for BC, DN-C and DN-H respectively; p = 0.580) increased similarly. CONCLUSIONS Single-dose DN cardioplegia with or without topical cooling offered comparable biventricular myocardial protection to multi-dose BC for a 60-min arrest in sheep.
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Affiliation(s)
- Marcin Malinowski
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
- Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Monica Solarewicz
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Ryan Farley
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Jose Rios Salcido
- Division of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI, USA
| | - Jared Bush
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Brian MacDoughall
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | | | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
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Borulu F, Arslan Ü, Çalik ES, Tayfur K, Erkut B. Comparison of Del Nido (a different application) and crystalloid blood cardioplegia on arrhythmia and early results. J Cardiothorac Surg 2024; 19:230. [PMID: 38627733 PMCID: PMC11020853 DOI: 10.1186/s13019-024-02675-1] [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: 09/19/2023] [Accepted: 03/23/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The results of the use of del-Nido(DN) solution using a different method or crystalloid blood cardioplegia in coronary bypass patients were compared. We aimed to investigate the effects on intraoperative and postoperative arrhythmias, arrhythmia durations and early results. METHODS The study included 175 patients using crystalloid blood cardioplegia (Group 1) and 150 patients using DN solution(Group 2). In the DN group, 75% of the calculated plegia dose was given first. the remaining part was applied by giving from grafts. Intraoperative/postoperative data were compared. RESULTS There was no significant difference between the groups in terms of demographic characteristics. Preop troponin level was similar.(p = 0.190) However, there was a statistical difference between the postoperative 6th hour.(p = 0.001) There was no difference in troponin values at the postoperative 24th hour. (p = 0.631) Spontaneous rhythm occurred at the cardiopulmonary by pass (CPB) weaning stage in most of the patients in Group 2 (95.3%). Although the need for temporary pacing was less in Group 2, it was not significant.(p = 0.282) No patient required permanent pacing. CPB duration, cross clamp times and intraoperative glucose levels, intensive care follow-up times and hospitalization times were found to be shorter in Group 2. Although the postoperative atrial fibrillation frequency was similar (p = 0.261), the time to return to sinus was lower in Group 2.(p = 0.001). CONCLUSION The use of DN cardioplegia solution provides significant positive contributions to avoid arrhythmias compared to crystalloid blood cardioplegia. DN solution applied with this method may contribute to reducing the anxieties associated with its use in isolated coronary artery bypass surgery.
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Affiliation(s)
- Ferhat Borulu
- Faculty of Medicine, Department of Cardiovascular Surgery, Ordu University, Ordu, Turkey.
| | - Ümit Arslan
- Faculty of Medicine, Department of Cardiovascular Surgery, Atatürk University, Erzurum, Turkey
| | - Eyüp Serhat Çalik
- Faculty of Medicine, Department of Cardiovascular Surgery, Atatürk University, Erzurum, Turkey
| | - Kaptanıderya Tayfur
- Faculty of Medicine, Department of Cardiovascular Surgery, Ordu University, Ordu, Turkey
| | - Bilgehan Erkut
- Faculty of Medicine, Department of Cardiovascular Surgery, Ordu University, Ordu, Turkey
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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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Kirmani BH, Shirley S, Kandaswamy M, Steele DJK. Cardioplegia-and science-for global surgery. Eur J Cardiothorac Surg 2024; 65:ezae068. [PMID: 38409742 DOI: 10.1093/ejcts/ezae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 02/28/2024] Open
Affiliation(s)
- Bilal H Kirmani
- Dept of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Sarah Shirley
- Dept of Clinical Perfusion, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Duncan J K Steele
- Dept of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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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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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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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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Park SU, Bae YH, Kim YS, Song K, Jang WS. Surgical results of only antegrade del Nido cardioplegia infusion in conventional coronary artery bypass grafting: a retrospective study. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:S23-S28. [PMID: 37376736 DOI: 10.12701/jyms.2023.00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Additional retrograde cardioplegia infusion in conventional coronary artery bypass grafting (CABG) was introduced to address the concern of inappropriate cardioplegia delivery through the stenotic coronary artery. However, this method is complex and requires repeated infusions. Therefore, we investigated the surgical outcomes of only antegrade cardioplegia infusion in conventional CABG. METHODS We included 224 patients who underwent isolated CABG between 2017 and 2019. The patients were divided into two groups according to the cardioplegia infusion method: antegrade cardioplegia infusion with del Nido solution (n=111, group I) and antegrade+retrograde cardioplegia infusion with blood cardioplegia solution (n=113, group II). RESULTS The sinus recovery time after release of the aorta cross-clamp was shorter in group I (3.8±7.1 minutes, n=98) than in group II (5.8±4.1 minutes, n=73) (p=0.033). The total cardioplegia infusion volume was lower in group I (1,998.6±668.6 mL) than in group II (7,321.0±2,865.3 mL) (p<0.001). Creatine kinase-MB levels were significantly lower in group I than in group II (p=0.039). Newly developed regional wall motion abnormalities on follow-up echocardiography were detected in two patients (1.8%) in group I and five patients (4.4%) in group II (p=0.233). There was no significant difference in ejection fraction improvement between the two groups (3.3%±9.3% in group I and 3.3%±8.7% in group II, p=0.990). CONCLUSION The only antegrade cardioplegia infusion strategy in conventional CABG is safe and has no harmful effects.
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Affiliation(s)
- Sang-Uk Park
- Department of Thoracic and Cardiovascular Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Yo Han Bae
- Department of Thoracic and Cardiovascular Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Yun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Kyungsub Song
- Department of Thoracic and Cardiovascular Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Woo Sung Jang
- Department of Thoracic and Cardiovascular Surgery, Keimyung University School of Medicine, Daegu, Korea
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Pozzoli A, Gabriella Surace G, Torre T, Bagnato P, Gallo M, Toto F, Ferrari E, Demertzis S. del Nido versus hematic cardioplegia in minimally invasive aortic valve surgery. Asian Cardiovasc Thorac Ann 2023; 31:795-801. [PMID: 37876227 DOI: 10.1177/02184923231209858] [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: 10/26/2023]
Abstract
BACKGROUND The quality of a myocardial protection of a single-dose del Nido cardioplegia versus multiple dose blood-based cardioplegia on myocardial injury, outcomes and operative times in patients undergoing minimally invasive aortic valve replacement is basically unreported. METHODS AND RESULTS Preoperative and post-operative data, as well as technical details from isolated minimally invasive aortic valve replacements, performed using single-dose or multiple-dose cardioplegia were prospectively collected and retrospectively analysed. A total of 110 patients undergoing minimally invasive valve replacements at our institution composed two groups: 55 patients in the blood cardioplegia group (BloCa) and 55 in the del Nido group (DeNiCa). The two-matched groups were comparable in terms of preoperative variables. In the DeNiCa group, there was a statistically significant less need for cardiac defibrillation after aortic cross-clamp release (p < 0.001). Moreover, the BloCa group received intraoperatively more blood transfusions (p = 0.001) and more insulin administration for higher glucose levels (p < 0.001). The BloCa group showed higher intraoperative lactate levels (p = 0.01). Need for post-operative inotropic and vasoactive support, Creatine Kinase-MB levels after 6 and 12 h, onset of post-operative atrial fibrillation and length of stay were similar. No deaths occurred in neither groups. CONCLUSION Single-dose del Nido cardioplegia in the setting of minimally invasive aortic surgery seems to offer adequate myocardial protection, comparable to multiple dose hematic cardioplegia. It has been documented a lower peri-operative need of defibrillation after cross-clamp release, lactate- and glucose peak values, as well as less blood transfusions compared to blood cardioplegic strategy.
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Affiliation(s)
- Alberto Pozzoli
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | | | - Tiziano Torre
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Pietro Bagnato
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Michele Gallo
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Francesca Toto
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Enrico Ferrari
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Stefanos Demertzis
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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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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12
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Huang Y, Yan S, Song Y, Wang X, Yang K, Zhang L, Gui W, Wang J, Yang Y, Xie Y, Wang D, Li X. Del nido versus conventional blood cardioplegia in patients with obstructive hypertrophic cardiomyopathy. Perfusion 2023:2676591231163270. [PMID: 36921566 DOI: 10.1177/02676591231163270] [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: 03/17/2023]
Abstract
BACKGROUND Myocardial protection is essential in cardiac surgery with cardiopulmonary bypass The Del Nido cardioplegia which was initially used in pediatric cardiac surgery, has been increasingly used in adult cardiac surgery recently. However, no literature has reported the efficacy of DNC in hypertrophic obstructive cardiomyopathy. METHODS This retrospective study involved elective patients who underwent extended surgical myectomy with or without concomitant cardiac surgical procedures between September 2017 and June 2022. Patients were distributed into two groups, the DNC and the CBC group. The primary outcome was high-sensitivity cardiac troponin I (hs-TnI) and creatine kinase-MB (CK-MB) levels at the 0, 1, and 2 postoperative days. The secondary outcomes contained: intraoperative LVEF, return to spontaneous rhythm; postoperative myocardial infarction, worsening or deteriorating of EF, mechanical circulatory support; new-onset atrial fibrillation; mechanical ventilation duration; intensive care unit hours; in-hospital days. RESULTS Fifty-nine patients were included and divided into the CBC (n = 15) and the DNC group (n = 44). There was no statistical difference in patients' demographics and preoperative parameters between the two groups. No in-hospital mortality. The total cardioplegia volume [21.93(18.36,26.07) vs. 25.68(23.17,37.12), p = 0.012] and infusion times [1(1,1) vs. 2(2,3), p = 0.000] were less and the incidence of return to spontaneous rhythm after declamping was higher in the DNC group [97.7% vs. 73.3%, p = 0.013]. Postoperative hs-TnI and CK-MB levels were comparable between the two groups. A longer DNC infusion interval was associated with higher levels of CK-MB on postoperative day 1 and day 2 (p = 0.009 and p = 0.011, respectively). CONCLUSIONS The use of DNC in extended surgical myectomy procedure was as safe and effective as CBC. However, DNC infusion interval over 60 minutes was associated with increased postoperative CK-MB levels.
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Affiliation(s)
- Yingshan Huang
- Department of Cardiopulmonary Bypass, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Shujie Yan
- Department of Cardiopulmonary Bypass, State key laboratory of Cardiovascular Medicine, Fuwai Hospital, National center for Cardiovascular disease, Chinese Academy of Medical science and Peking Union Medical College, Beijing, China
| | - Yi Song
- Department of Cardiopulmonary Bypass, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Xiaoqi Wang
- Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Ke Yang
- Department of Anesthesiology, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Ling Zhang
- Department of Cardiopulmonary Bypass, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Wenting Gui
- Department of Cardiopulmonary Bypass, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Jiao Wang
- Department of Cardiopulmonary Bypass, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Yunling Yang
- Department of Cardiopulmonary Bypass, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Yan Xie
- Department of Cardiopulmonary Bypass, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Dongmei Wang
- Department of Cardiopulmonary Bypass, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Xinyue Li
- Department of Cardiopulmonary Bypass, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
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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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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: 2] [Impact Index Per Article: 2.0] [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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Bishawi M, Milano CA. Treatment of Perioperative Ischemia, Infarction, and Ventricular Failure in Cardiac Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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17
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Duan L, Hu GH, Wang E, Zhang CL, Huang LJ, Duan YY. Del Nido versus HTK cardioplegia for myocardial protection during adult complex valve surgery: a retrospective study. BMC Cardiovasc Disord 2021; 21:604. [PMID: 34922443 PMCID: PMC8683821 DOI: 10.1186/s12872-021-02411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Histidine-tryptophan-ketoglutarate (HTK) and del Nido (DN) cardioplegia are intracellular-type and extracellular-type solution respectively, both can provide a long period of myocardial protection with single-dose infusion, but studies comparing the two are rare for adult cardiac surgery. This study aims to evaluate whether DN is suitable for cardioplegia in complex and high-risk valve surgery with long-term cardiac ischemia when compared with HTK. METHODS The perioperative records of adult patients infused with DN/HTK as a cardioplegic solution who underwent complex valve surgery with an expected myocardial ischaemic duration longer than 90 min between Oct 2018 and Oct 2019 were analysed retrospectively. RESULTS Of the 160 patients who received DN/HTK and underwent complex valve surgery, we propensity matched 73 pairs. Both groups achieved satisfactory cardiac arrest effects, and no significant difference was found in their cTnI and CK-MB levels within 12 to 72 h postoperatively. The DN group had a higher rate of return to spontaneous rhythm (0.88 v 0.52, P < 0.001), a lower frequency of postoperative severe arrythmias (12% v 26%, P = 0.036), a higher postoperative stroke volume (65 v 59 ml, P = 0.011) and a higher cardiac output (6.0 v 4.9 L/min, P = 0.007) as evaluated by echocardiography, fewer transfusions and shorter ICU stays (both P < 0.05). The two groups had similar inotrope usage and similar incidences of low cardiac output, morbidities and mortality. Subgroup analysis showed that when the aortic clamping time was greater than 120 min, the advantages of DN were weakened. CONCLUSIONS DN can be safely applied to complex valve surgery, and it has a similar myocardial protection effect as HTK. Further prospective studies are required to verify these retrospective findings. Trial registration retrospectively registered.
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Affiliation(s)
- Lian Duan
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Guo-Huang Hu
- Department of Surgery, Affiliated Changsha Hospital of Hunan Normal University, Changsha, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China.
| | - Cheng-Liang Zhang
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ling-Jin Huang
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yan-Ying Duan
- Department of Occupational and Environmental Health, Public Health School, Central South University, Changsha, China
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Rai G, Chandrababu R, Sevagur Kamath G, Pai B S. Analogy of Del Nido and conventional cardioplegia in patients undergoing isolated mitral valve replacement surgery: A single-center retrospective study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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19
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Almeida AS, Ceron RO, Anschau F, Kopittke L, Lira KB, Delvaux RS, Rode J, Rey RAW, Wittke EI, Rombaldi AR. Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial. BMJ Open 2021; 11:e047942. [PMID: 34489276 PMCID: PMC8422325 DOI: 10.1136/bmjopen-2020-047942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Myocardial protection is essential for successful cardiac surgery, and the search for an ideal cardioplegic solution has continued since its beginning. In this context, Custodiol, del Nido and modified del Nido are single-dose cardioplegic solutions with good safety profiles and great relevance in modern surgical practice. While these solutions have all been evaluated for their impact on patient outcomes independently, limited research exists comparing them directly. Thus, the present study aims to examine the effects of these cardioplegic solutions on myocardial protection and clinical outcomes in adult patients undergoing elective cardiac surgery. The assessment of the increase in myocardial injury biomarkers in patients submitted to all treatment methods may be considered a major strength of our study. METHODS AND ANALYSIS This is a clinical trial study protocol that will compare myocardial protection and clinical outcomes among three patient groups based on which cardioplegic solution was used. Patients will be randomised to receive del Nido (n=30), modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers will be measured at the baseline and 2 hours, 12 hours and 24 hours after the cardiopulmonary bypass. Clinical outcomes will be assessed during the trans operative period and the intensive care unit stay, in addition to other haematological parameters. ETHICS AND DISSEMINATION This protocol and its related documents were approved by the Research Ethics Committee of the Hospital Nossa Senhora da Conceição, Brazil, registered under no. 4.029.545. The findings of this study will be published in a peer-reviewed journal in the related field. TRIAL REGISTRATION NUMBER RBR-7g5s66.
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Affiliation(s)
- Adriana Silveira Almeida
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
- Health Technology Assessment Center (NATS) and Education and Research Center (GEP), Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafael Oliveira Ceron
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernando Anschau
- Health Technology Assessment Center (NATS) and Education and Research Center (GEP), Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciane Kopittke
- Health Technology Assessment Center (NATS) and Education and Research Center (GEP), Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Kathize Betti Lira
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Renan Senandes Delvaux
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juarez Rode
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Estefânia Inês Wittke
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Alfeu Roberto Rombaldi
- Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
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Sanrı US, Özsin KK, Toktaş F, Yavuz Ş. Comparison of Del Nido Cardioplegia and Blood Cardioplegia in Terms of Development of Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting. Braz J Cardiovasc Surg 2021; 36:158-164. [PMID: 34048202 PMCID: PMC8163282 DOI: 10.21470/1678-9741-2020-0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Del Nido cardioplegia (DNC) has been used in pediatric cardiac surgery for many years with a single dose application and its usage in adult cardiac surgery has been increasing in recent years, with results being published. In this study, we aimed to investigate the effect of DNC on the development of postoperative atrial fibrillation (PoAF). Methods In this retrospective observational comparative study, 255 patients who underwent isolated on-pump coronary artery bypass grafting, between January 2019 and November 2019, were enrolled. The patients were divided into two groups: DNC (n=132) and blood cardioplegia (BC) (n=123). Intraoperative and postoperative data were evaluated and compared in terms of the development of PoAF. Results We found that the development of PoAF and the length of hospital stay remain significantly higher in the BC group (P=0.044, P<0.001, respectively). In addition, the aortic cross-clamp time and the cardioplegia volume delivered were significantly lower in the DNC group (P=0.042, P<0.001, respectively). In multivariate logistic regression analysis, only higher cardioplegia volume was determined as an independent predictor for PoAF development (OR 1.001; 95% CI 1.000-1.001; P=0.033). We did not found difference between groups in terms of troponin T, inotropic drug support, need for intraaortic balloon pump and mortality. Conclusion This study showed that DNC can be used safely in adult coronary bypass surgery and PoAF development effect is reduced.
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Affiliation(s)
- Umut Serhat Sanrı
- Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Kadir Kaan Özsin
- Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Faruk Toktaş
- Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Şenol Yavuz
- Department of Cardiovascular Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Shu C, Hong L, Shen X, Zhang W, Niu Y, Song X, Kong J, Zhang C. Effect of Del Nido cardioplegia on ventricular arrhythmias after cardiovascular surgery. BMC Cardiovasc Disord 2021; 21:32. [PMID: 33441080 PMCID: PMC7805093 DOI: 10.1186/s12872-020-01844-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Del Nido cardioplegia (DNC) has been proven safe and effective in pediatric patients. However, the use of DNC in adult undergoing cardiovascular surgery lacks support with substantial evidence. This study aimed to evaluate the efficacy of DNC as a cardioplegia of prophylaxis to ventricular arrhythmias associated to cardiovascular surgery in adult patients. METHODS This study recruited nine hundred fifty-four patients who underwent cardiopulmonary bypass surgeries in Nanjing Hospital affiliated to Nanjing Medical University between January 2019 and December 2019. Among 954 patients, 324 patients were treated with DNC (DNC group), and 630 patients were treated with St. Thomas cardioplegia (STH group). The incidence of postoperative arrhythmia as well as other cardiovascular events relavant to the surgery were investigated in both groups. RESULTS In DNC group, the incidence of postoperative ventricular arrhythmias was lower (12.4% vs. 17.4%, P = 0.040), and the length of ICU stay was shorter (1.97 ± 1.49 vs. 2.26 ± 1.46, P = 0.004). Multivariate logistic regression demonstrated that the use of DNC helped to reduce the incidence of postoperative ventricular arrhythmias (adjusted odds ratio 0.475, 95% CI 0.266-0.825, P = 0.010). The propensity score-based analysis and subgroup analysis indicated that DNC has the same protecting effects towards myocardial in all kinds of cardiopulmonary bypass surgeries. CONCLUSIONS Del Nido cardioplegia may potentially reduce the incidence of postoperative ventricular arrhythmias, shorten the length of ICU stay and improve the overall outcome of the patients undergoing cardiovascular surgery.
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Affiliation(s)
- Chang Shu
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu Province, China
| | - Liang Hong
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu Province, China
| | - Xiao Shen
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu Province, China
| | - Wenhao Zhang
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu Province, China
| | - Yongsheng Niu
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu Province, China
| | - Xiaochun Song
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu Province, China
| | - Jie Kong
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu Province, China
| | - Cui Zhang
- Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu Province, China.
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22
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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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23
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Lee CH, Kwon Y, Park SJ, Lee JW, Kim JB. Comparison of del Nido and histidine-tryptophan-ketoglutarate cardioplegic solutions in minimally invasive cardiac surgery. J Thorac Cardiovasc Surg 2020; 164:e161-e171. [PMID: 33487412 DOI: 10.1016/j.jtcvs.2020.11.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We examined the safety and efficacy of del Nido cardioplegic solution compared with histidine-tryptophan-ketoglutarate cardioplegic solution in minimally invasive cardiac surgery. METHODS Patients who underwent minimally invasive cardiac surgery using del Nido or histidine-tryptophan-ketoglutarate from 2015 to 2019 were enrolled. Various clinical outcomes were compared between the groups. Postoperative laboratory findings including the levels of electrolytes, cardiac enzymes (creatine kinase-MB and troponin I), and serial blood lactate were also measured and compared. Based on 28 baseline covariates, propensity score matching was performed to reduce selection bias. RESULTS Among 766 patients, del Nido and histidine-tryptophan-ketoglutarate were used in 330 patients (43.1%) and 436 patients (56.9%), respectively. There were no significant intergroup differences in postoperative clinical outcomes and early adverse outcomes among 228 pairs of propensity score-matched patients. Immediate postoperative sodium levels were within the normal range in both groups without a significant difference (P = .50). However, peak creatine kinase-MB (median, 31.9 vs 37.7 ng/mL, P = .026) and troponin I (6.9 vs 9.1 ng/mL, P = .014) levels were significantly lower in the del Nido group. Linear regression analysis revealed a significant association between the peak cardiac enzyme levels and the cardiac ischemic time depending on the cardioplegia type, with lower cardiac isoenzymes for del Nido over histidine-tryptophan-ketoglutarate (P < .001) until the crossover point at the cardiac ischemic time over 100 minutes. CONCLUSIONS In comparison with histidine-tryptophan-ketoglutarate solution, del Nido solution seems to have acceptable safety and efficacy with good myocardial protection in minimally invasive cardiac surgery. Further studies focusing on complex surgeries requiring longer cardiac ischemic time are needed.
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Affiliation(s)
- Chee-Hoon Lee
- Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Seoul, South Korea
| | - Youngkern Kwon
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Sung Jun Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
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24
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Gunaydin S, Akbay E, Gunertem OE, McCusker K, Onur MA, Ozisik K. Long-Term Protective Effects of Single-Dose Cardioplegic Solutions in Cell Culture Models. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2020; 52:279-288. [PMID: 33343030 PMCID: PMC7728504 DOI: 10.1182/ject-2000028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/13/2020] [Indexed: 11/20/2022]
Abstract
Despite the popularity of single-dose cardioplegic techniques, the time window and targeted population for successful reperfusion remain unclear. We tested currently available techniques based on cell viability and integrity to demonstrate long-term cardioprotection and clarify whether these solutions were performed on neonatal/adult endothelium and myocardium by examining different cell lines. Cell viability with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test proliferation assay and membrane integrity with the lactic dehydrogenase (LDH) cytotoxicity test were documented in a cell culture/microscopy setting on adult (human umbilical vein endothelium [HUVEC]), neonatal (H9C2-cardiomyocytes), and myofibroblast (L929) cell lines. Apoptotic cell activity and necrosis were evaluated by acridine orange/propidium iodide (AO/PI) staining. Twenty-four hours after seeding, cells were incubated in control (Dulbecco's modified Eagle), St. Thomas and blood cardioplegia (4:1), histidine-tryptophan-ketoglutarate (HTK), and del Nido solutions at 32°C followed by an additional 6, 24, and 48 hours in standard conditions (37°C, 5% CO2). Experiments were repeated eight times. In MTT cell viability analysis, HTK protection was significantly better than the control medium in L929 cell lines at 48th hours follow-up and acted markedly better on the HUVEC cell line at 24th and 48th hours. del Nido and HTK provided significantly better protection on H9C2 (at 24th and 48th hours). Apoptotic and necrotic cell scoring as a result of AO/PI staining was found consistent with MTT results. The LDH test demonstrated that the level of cell disruption was significantly higher for St. Thomas and blood cardioplegia in H9c2 cells. Experimental studies on cardioplegia aimed at assessing myocardial protection use time-consuming and often expensive approaches that are unrealistic in clinical practice. We have focused on identifying the most effective cell types and the direct consequences of different cardioplegia solutions to document long-term effects that we believe are the most underestimated ones in the cardioplegia literature.
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Affiliation(s)
- Serdar Gunaydin
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey; Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey; and Department of Cardiac Surgery, New York Medical College, New York, New York
| | - Esin Akbay
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey; Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey; and Department of Cardiac Surgery, New York Medical College, New York, New York
| | - Orhan Eren Gunertem
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey; Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey; and Department of Cardiac Surgery, New York Medical College, New York, New York
| | - Kevin McCusker
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey; Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey; and Department of Cardiac Surgery, New York Medical College, New York, New York
| | - Mehmet Ali Onur
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey; Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey; and Department of Cardiac Surgery, New York Medical College, New York, New York
| | - Kanat Ozisik
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey; Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey; and Department of Cardiac Surgery, New York Medical College, New York, New York
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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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Gunaydin S, Akbay E, Gunertem OE, McCusker K, Kunt AT, Onur MA, Ozisik K. Comparative Effects of Single-Dose Cardioplegic Solutions Especially in Repeated Doses During Minimally Invasive Aortic Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 16:80-89. [PMID: 33155876 DOI: 10.1177/1556984520967119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aims to compare del Nido cardioplegia (DNC) and histidine-tryptophan-ketoglutarate (HTK) cardioplegic solutions in minimally invasive aortic valve replacement (mini-AVR) surgery to discuss the safety level of myocardial protection and rationale for redosing intervals. METHODS During the period from January 2017 to June 2019, 200 patients undergoing mini-AVR (solely or with concomitant procedures) were prospectively randomized to DNC (n = 100) andHTK (n = 100), both up to 90 minutes ischemic time. Patients with ischemic time over 90 minutes, needing a redosing, were further analyzed in 2 subgroups with DNC-R (n = 30) and HTK-R (n = 36). Sensitive biomarkers, in addition to routine biochemistry, were also documented at baseline (T1), after cessation of cardiopulmonary bypass (T2), and on the first postoperative day (T3). Transmural myocardial biopsies were sampled for staining. RESULTS No statistical differences could be demonstrated in DNC and HTK groups with up to 90 minutes cross-clamp times in routine biochemical measurements and basic perioperative clinical outcomes. DNC-R showed significantly more arrhythmia/AV block incidence resulting in more extended intensive care unit (ICU) stay. Interleukin-6 and syndecan-1 in DNC and DNC-R groups were substantially higher at T2. Aquaporin-4 levels were significantly lower in the DNC-R group, demonstrating unsatisfactory response of cells to an excessive volume at T2. CONCLUSIONS DNC and HTK provided acceptable myocardial protection as single-dose applications. DNC-R had significantly unbalanced levels of biomarkers, and more arrhythmia/AV block incidence resulting in more extended ICU stay. For patients who may need redosing HTK may be preferable to DNC.
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Affiliation(s)
- Serdar Gunaydin
- 448249 Department of Cardiovascular Surgery, Ankara City Hospital, Turkey
| | - Esin Akbay
- 198375 Faculty of Science, Hacettepe University, Ankara, Turkey
| | | | | | - Atike Tekeli Kunt
- 448249 Department of Cardiovascular Surgery, Ankara City Hospital, Turkey
| | - Mehmet Ali Onur
- 198375 Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Kanat Ozisik
- 448249 Department of Cardiovascular Surgery, Ankara City Hospital, Turkey
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28
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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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Gunaydin S, Gunertem OE, Babaroglu S, Kunt AT, McCusker K, Ozisik K. Clinical outcomes of single-dose cardioplegia in high-risk coronary bypass. Asian Cardiovasc Thorac Ann 2020; 29:77-83. [PMID: 33530706 DOI: 10.1177/0218492320966434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the increasing popularity of single-dose cardioplegia techniques in coronary artery bypass grafting, the time window for successful reperfusion remains unclear. This study aimed to compare different cardioplegic techniques based on early and 30-day clinical outcomes via thorough monitoring. METHODS This prospective cohort study included high-risk patients undergoing coronary artery bypass grafting and receiving 3 different types of cardioplegia between January 2017 and June 2019. Group 1 (n = 101) had a single dose of del Nido cardioplegia, group 2 (n = 92) had a single dose of histidine-tryptophane-ketoglutarate, and group 3 (n = 119) had cold blood cardioplegia. Patients were examined perioperatively by memory loop recording and auto-triggered memory loop recording for 30 days, with documentation of predefined events. RESULTS Interleukin-6 and cardiac troponin levels in group 1 were significantly higher than those in groups 2 and 3. The incidence of predefined events as markers of inadequate myocardial protection was significantly higher group 1, with more frequent atrial fibrillation attacks and more hospital readmissions. The readmission rate was 17.6% in group 1, 9% in group 2, and 8% in group 3. CONCLUSIONS Our data demonstrate the long-term efficacy of cardioplegic techniques, which may become more crucial in high-risk patients who genuinely have a chance to benefit from adjunct myocardial protection. Patients given del Nido cardioplegia had a significantly more prominent inflammatory response and higher troponin levels after cardiopulmonary bypass. This group had issues in the longer term with significantly more cardiac events and a higher rehospitalization rate.
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Affiliation(s)
- Serdar Gunaydin
- Department of Cardiovascular Surgery, City Hospital Campus, University of Health Sciences, Ankara, Turkey
| | - Orhan Eren Gunertem
- Department of Cardiovascular Surgery, City Hospital Campus, University of Health Sciences, Ankara, Turkey
| | - Seyhan Babaroglu
- Department of Cardiovascular Surgery, City Hospital Campus, University of Health Sciences, Ankara, Turkey
| | - Atike Tekeli Kunt
- Department of Cardiovascular Surgery, City Hospital Campus, University of Health Sciences, Ankara, Turkey
| | - Kevin McCusker
- Department of Cardiac Surgery, New York Medical College, New York, USA
| | - Kanat Ozisik
- Department of Cardiovascular Surgery, City Hospital Campus, University of Health Sciences, Ankara, Turkey
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Algarni KD. Routine use of del Nido cardioplegia compared with blood cardioplegia in all types of adult cardiac surgery procedures. J Card Surg 2020; 35:3340-3346. [DOI: 10.1111/jocs.15060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/04/2020] [Accepted: 09/12/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Khaled D. Algarni
- Department of Cardiac Sciences, College of Medicine King Saud University Riyadh Saudi Arabia
- Department of Adult Cardiac Surgery Prince Sultan Cardiac Center Riyadh Saudi Arabia
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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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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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Kirişci M, Koçarslan A, Altintaş Aykan D, Alkan Baylan F, Doğaner A, Orak Y. Evaluation of the cardioprotective effects of crystalloid del Nido cardioplegia solution via a rapid and accurate cardiac marker: heart-type fatty acid-binding protein. Turk J Med Sci 2020; 50:999-1006. [PMID: 32394686 PMCID: PMC7379457 DOI: 10.3906/sag-2002-53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/10/2020] [Indexed: 01/18/2023] Open
Abstract
Background/aim Our aim in this study was to compare the efficacy and safety of crystalloid del Nido solution and cold blood cardioplegia solution on clinical and laboratory parameters. Materials and methods Sixty patients who underwent elective coronary bypass operation between July 2019 and January 2020 were included in our study. Patients were divided into 2 groups of 30 patients using del Nido solution (DNS) and cold blood cardioplegia solution (CBCS), which were given for cardiac arrest. Demographic data, preoperative, postoperative 0th h, 6th h and 4th day creatine kinase myocardial band (CK-MB) and troponin I values were compared with a specific cardiac enzyme heart-type fatty acid-binding protein (H-FABP). Results We found that aortic cross clamp duration and cardiopulmonary bypass (CPB) time were shorter in patients using del Nido solution than cold blood cardioplegia solution (57.30 ± 23.57 min, 76.07 ± 27.18 min, P = 0.006) (95.07 ± 23.06 min, 114.13 ± 33.93, P = 0.014). Total cardioplegia solution volume was higher in the cold blood cardioplegia solution group (1426.67 ± 416.00 vs. 1200 ± 310.73 P = 0.02). Preoperative and postoperative levels of cardiac enzymes including CK-MB, troponin I and H-FABP were comparable in del Nido solution and cold blood cardioplegia solution groups. Conclusion According to these results, when we compare both demographic data and CK-MB, troponin I and H-FABP levels, both cardioplegia solutions were comparable regarding safety and efficacy in terms of myocardial protection.
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Affiliation(s)
- Mehmet Kirişci
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Aydemir Koçarslan
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Duygun Altintaş Aykan
- Department of Pharmacology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Filiz Alkan Baylan
- Department of Biochemistry, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Adem Doğaner
- Department of Biostatistics, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Yavuz Orak
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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Ler A, Sazzad F, Ong GS, Kofidis T. Comparison of outcomes of the use of Del Nido and St. Thomas cardioplegia in adult and paediatric cardiac surgery: a systematic review and meta-analysis. Perfusion 2020; 35:724-735. [DOI: 10.1177/0267659120919350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: In recent years, the use of del Nido cardioplegia, initially intended for paediatric cardiac surgery, has been extended to adult cardiac surgery in many institutions. Our aim was thus to compare the outcomes of the use of del Nido cardioplegia with that of conventional cardioplegia and discuss its role in both adult and paediatric cardiac surgery. Method: A systematic literature search was conducted in August 2019 on Medline (via PubMed), Embase and Cochrane electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Any retrospective studies and randomised controlled trials that reported findings comparing the outcomes of the use of del Nido cardioplegia with that of St. Thomas cardioplegia were included. Results: We observed shorter aortic cross-clamp time (mean difference: −15.18, confidence interval: −27.21 to −3.15, p = 0.01) and cardiopulmonary bypass time (mean difference: −13.52, confidence interval: −20.64 to −6.39, p = 0.0002) associated with the use of del Nido cardioplegia in adult cardiac surgery as compared to St. Thomas cardioplegia. Defibrillation rates were significantly lower in patients who had been given del Nido cardioplegia, in both adult (relative risk: 0.28, confidence interval: 0.12 to 0.64, p = 0.003) and paediatric patients (relative risk: 0.25, confidence interval: 0.08 to 0.79, p = 0.02). Conclusion: Del Nido cardioplegia may be a viable alternative to the use of St. Thomas cardioplegia in both adult and paediatric patients, providing similar postoperative outcomes while also affording the additional advantage of shorter aortic cross-clamp time and cardiopulmonary bypass time (in adult cardiac surgery) and decreased rates of defibrillation (in both adult and paediatric cardiac surgery).
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Affiliation(s)
- Ashlynn Ler
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Faizus Sazzad
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
- Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Geok Seen Ong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
| | - Theo Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
- Cardiovascular Research Institute, National University of Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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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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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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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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Luo W, Bouhout I, Demers P. The del Nido cardioplegia in adult cardiac surgery: reinventing myocardial protection? J Thorac Dis 2019; 11:S367-S369. [PMID: 30997223 DOI: 10.21037/jtd.2018.12.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Wenzong Luo
- Department of Cardiac Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310007, China
| | - Ismail Bouhout
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal School of Medicine, Quebec, Canada
| | - Philippe Demers
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal School of Medicine, Quebec, Canada
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Kavala AA, Turkyilmaz S. Comparison of del Nido Cardioplegia with Blood Cardioplegia in Coronary Artery Bypass Grafting Combined with Mitral Valve Replacement. Braz J Cardiovasc Surg 2019; 33:496-504. [PMID: 30517259 PMCID: PMC6257536 DOI: 10.21470/1678-9741-2018-0152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/31/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare del Nido cardioplegia (DNC) with blood cardioplegia (BC) in coronary artery bypass grafting (CABG) combined with mitral valve replacement. METHODS A 3-year single-center retrospective cohort study was carried out. Subjects who underwent CABG (up to triple bypass) combined with mitral valve replacement were divided into DNC and BC groups. Each group had thirty subjects. RESULTS Both groups demonstrated similar baseline characteristics, including age, gender, cardiac/non-cardiac comorbidity, and preoperative echocardiographic parameters. Compared with the BC group, the DNC group demonstrated significantly lower cardioplegia volume (BC = 1130.00±194.1 mL, DNC = 884.33±156.8 mL, P=0.001), cardiopulmonary bypass time (DNC = 110.90±12.52 min, BC = 121.70±13.57 min, P=0.002), aortic clamp time (DNC = 91.37±11.58 min, BC = 101.37±13.87 min, P=0.004), and need for intraoperative defibrillation (DNC = 6 events, BC = 21 events, P=0.001). Postoperative creatine kinase-MB levels and troponin levels were significantly lower in the DNC group than in the BC group. Postoperative haemoglobin and haematocrit levels were significantly higher in the DNC group than in the BC group. The intubation period (hours) in intensive care unit (ICU) was significantly small in the BC group (DNC = 8.13±12.21, BC = 6.82±1.57, P=0.037); however, ICU stay, total hospital stay, and postoperative complication rates were not significantly different between them. At pre-discharge echocardiography, the DNC group demonstrated significantly higher ejection fraction rates than the BC group (47.79±5.50 and 45.72±5.86, respectively, P=0.005). CONCLUSION DNC presented better intraoperative and postoperative parameters and it is an effective and safe alternative to BC for CABG combined with mitral valve replacement.
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Affiliation(s)
- Ali Aycan Kavala
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Saygin Turkyilmaz
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Cayir MC, Yuksel A. The Use of del Nido Cardioplegia for Myocardial Protection in Isolated Coronary Artery Bypass Surgery. Heart Lung Circ 2019; 29:301-307. [PMID: 30723044 DOI: 10.1016/j.hlc.2018.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/11/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The del Nido (DN) cardioplegia solution has been widely used in paediatric open-heart surgery for years; however, its application in adult open-heart surgery has not yet gained sufficient popularity. We investigated the safety and efficiency of the DN cardioplegia solution versus the traditional crystalloid cardioplegia solution [St. Thomas' Hospital (STH) cardioplegia solution] in adult patients undergoing coronary artery bypass grafting (CABG). METHODS A retrospective comparative analysis of 200 consecutive patients undergoing isolated on-pump CABG between April 2016 and September 2017 was performed. Patients were divided into two groups: DN group (n = 100) and STH group (n = 100). Groups were compared with regard to perioperative clinical outcomes, and the safety and efficiency of the DN cardioplegia solution in CABG surgery were evaluated. RESULTS In the DN group, mean aortic cross-clamp, cardiopulmonary bypass, and total operation times were significantly shorter than in the STH group. After the release of the aortic cross-clamp, the requirement for intraoperative defibrillation was significantly less in the DN group. There were no significant differences between the groups in terms of the levels of perioperative cardiac biomarkers (including creatine kinase-myocardial band and troponin I), major postoperative adverse events, and in-hospital mortality. CONCLUSIONS This study revealed that the use of the DN cardioplegia solution in adult patients undergoing isolated CABG provides significantly shorter aortic cross-clamp, cardiopulmonary bypass, and total operation times compared with the traditional cardioplegias solution. The DN solution could be used as a safe and efficient alternative to the traditional cardioplegia solutions in CABG surgery.
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Affiliation(s)
- Mustafa Cagdas Cayir
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ahmet Yuksel
- Department of Cardiovascular Surgery, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey.
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O'Donnell C, Wang H, Tran P, Miller S, Shuttleworth P, Boyd JH. Utilization of Del Nido Cardioplegia in Adult Coronary Artery Bypass Grafting - A Retrospective Analysis. Circ J 2018; 83:342-346. [PMID: 30531128 DOI: 10.1253/circj.cj-18-0780] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Studies assessing the safety and effectiveness of Del Nido cardioplegia for adult cardiac surgery remain limited. We investigated early outcomes after coronary artery bypass grafting (CABG) using single-dose Del Nido cardioplegia vs. conventional multi-dose blood cardioplegia. Methods and Results: The 81 consecutive patients underwent isolated CABG performed by a single surgeon. The initial 27 patients received anterograde blood cardioplegia, while the subsequent 54 patients received anterograde Del Nido cardioplegia. There were no differences in the baseline characteristics of each group nor any differences in the 30-day incidences of myocardial infarction, all-cause death, and readmission following surgery. The use of Del Nido cardioplegia was associated with shorter cardiopulmonary bypass time (98 vs. 115 min, P=0.011), shorter cross-clamp time (74 vs. 87 min, P=0.006), and decreased need for intraoperative defibrillation (13.0% vs. 33.3%, P=0.030) compared with blood cardioplegia. To control for the difference in cross-clamp time, we performed propensity score matching with a logistical treatment model and confirmed that Del Nido cardioplegia provided similar outcomes as blood cardioplegia and also reduced the need for defibrillation independent of cross-clamp time. CONCLUSIONS Compared with conventional blood cardioplegia, Del Nido cardioplegia provided excellent myocardial protection with reduced need for intraoperative defibrillation, shorter bypass and cross-clamp times, and comparable early clinical outcomes for adult patients undergoing CABG.
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Affiliation(s)
- Christian O'Donnell
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Phat Tran
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Shari Miller
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Paul Shuttleworth
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Jack H Boyd
- Department of Cardiothoracic Surgery, Stanford University School of Medicine
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Ucak HA, Uncu H. Comparison of Del Nido and Intermittent Warm Blood Cardioplegia in Coronary Artery Bypass Grafting Surgery. Ann Thorac Cardiovasc Surg 2018; 25:39-45. [PMID: 30089762 PMCID: PMC6388299 DOI: 10.5761/atcs.oa.18-00087] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose: In this study, we aim to investigate the efficacy and clinical results of using Del Nido solution (DNS) in coronary artery bypass grafting (CABG) surgery by comparing with intermittent warm blood cardioplegia (IWBC). Methods: Between March 2017 and February 2018, 297 adult patients who underwent primary isolated CABG surgery with cardiopulmonary bypass (CPB) were included in the study. We used DNS in 112 patients and IWBC was used in 185 patients. We compared both the clinical and the laboratory results. Results: Aortic cross-clamp time, CPB time, and peak glucose level are lower with DNS. But we did not observe any meaningful difference of clinical results between two methods including postoperative myocardial enzyme release. Conclusion: Del Nido cardioplegia was developed for immature heart and pediatric surgery. But in our opinion, it is a good and useful alternative to CABG surgery with similar results to IWBC.
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Affiliation(s)
- Haci Ali Ucak
- Department of Cardiovascular Surgery, University of Health Sciences Adana City Hospital, Adana, Turkey
| | - Hasan Uncu
- Department of Cardiovascular Surgery, University of Health Sciences Adana City Hospital, Adana, Turkey
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Heydarpour M, Ejiofor J, Gilfeather M, Stone G, Gorham J, Seidman CE, Seidman JG, Yammine M, Body SC, Aranki SF, Muehlschlegel JD. Molecular Genetics of Lidocaine-Containing Cardioplegia in the Human Heart During Cardiac Surgery. Ann Thorac Surg 2018; 106:1379-1387. [PMID: 30028983 DOI: 10.1016/j.athoracsur.2018.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND During cardiac surgery with cardiopulmonary bypass, delivery of cardioplegia solution to achieve electromechanical cardiac quiescence is obligatory. The addition of lidocaine to cardioplegia has advantages, although its consequences at a molecular level remain unclear. We performed whole-genome RNA sequencing of the human left ventricular (LV) myocardium to elucidate the differences between whole-blood (WB) cardioplegia with and without addition of lidocaine (LC) on gene expression. METHODS We prospectively enrolled 130 patients undergoing aortic valve replacement surgery. Patients received high-potassium blood cardioplegia either with (n = 37) or without (n = 93) lidocaine. The LV apex was biopsied at baseline, and after an average of 74 minutes of cold cardioplegic arrest. We performed differential gene expression analysis for 18,258 genes between these 2 groups. Clinical and demographic variables were adjusted in the model. Gene ontology (GO) and network enrichment analysis of the retained genes were performed using g:Profiler and Cytoscape. RESULTS A total of 1,298 genes were differentially expressed between cardioplegic treatments. Compared with the WB group, genes upregulated in the LC group were identified by network enrichment to play a protective role in ischemic injury by inhibiting apoptosis, increasing transferrin endocytosis, and increasing cell viability. Downregulated genes in the LC group were identified to play a role in inflammatory diseases, oxygen transport, and neutrophil aggregation. CONCLUSIONS The addition of lidocaine to cardioplegia had pronounced effects on a molecular level with genes responsible for decreased inflammation, reduced intracellular calcium binding, enhanced antiapoptotic protection, augmented oxygen accessibility through transferrins, and increased cell viability showing measurable differences.
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Affiliation(s)
- Mahyar Heydarpour
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julius Ejiofor
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Gilfeather
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory Stone
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Josh Gorham
- Department of Genetics, Harvard Medical School, Boston, Massachusetts
| | - Christine E Seidman
- Howard Hughes Medical Institute, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jon G Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts
| | - Maroun Yammine
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Simon C Body
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sary F Aranki
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Del Nido cardioplegia - what is the current evidence? POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 15:114-118. [PMID: 30069192 PMCID: PMC6066678 DOI: 10.5114/kitp.2018.76477] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/12/2018] [Indexed: 11/17/2022]
Abstract
Del Nido cardioplegia is believed to be both clinically and economically efficient. The interest in this myocardial protection method has been continuously growing. However, the evidence is not clear. The article summarizes recent reports regarding del Nido cardioplegia.
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Stammers AH, Tesdahl EA, Mongero LB, Stasko A. Does the type of cardioplegia used during valve surgery influence operative nadir hematocrit and transfusion requirements? Perfusion 2018; 33:638-648. [PMID: 29874956 DOI: 10.1177/0267659118777199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Myocardial protection is performed using diverse cardioplegic (CP) solutions with various combinations of chemical and blood constituents. Newer CP formulations that extend ischemic intervals may require greater asanguineous volume, contributing to hemodilution. METHODS We evaluated intraoperative hemodilution and red blood cell (RBC) transfusion rates among three common CP solutions during cardiac valve surgery. Data from 5,830 adult cardiac primary valve procedures where either four-to-one blood CP (4:1), del Nido solution (DN) or microplegia (MP) was used at 173 United States surgical centers. The primary outcome was the nadir hematocrit (Hct) during cardiopulmonary bypass (CPB), with a secondary outcome of total units of RBC transfused intraoperatively. Outcomes were assessed using mixed-effects regression, with controls for patient size, age, first Hct in the operating room, ultrafiltration volume, net bypass circuit priming volume, anesthesia and perfusion asanguineous volumes, cross-clamp and total procedure times, procedure type, reoperation, hospital, surgeon and twelve other patient and procedural variables. RESULTS A total of 2,641 patients received 4:1 (45.3%), 1,864 received DN (32.0%) and 1,325 received MP (22.7%). There were only slight differences in the central tendency (mean (SD)) for crude nadir Hct on CPB: 4:1, 25.5 (4.5), DN, 26.0 (4.6) and MP, 26.5 (4.7). After controlling for numerous operative and patient characteristics, the regression-adjusted estimate of the nadir Hct on CPB for MP was 26.2%, compared to 25.7% for 4:1 and 25.7% for DN; differences between MP and the other methods were statistically significant (p<0.01). Unadjusted mean RBC units transfused per patient was very similar across the groups (4:1, 2.2; MP, 2.3; DN, 2.4). Regression-adjusted estimates for the number of units of RBC transfused intraoperatively showed no statistically significant differences between CP methods. CONCLUSIONS In patients undergoing cardiac valve surgery, the type of CP did not have a strong clinical impact on hemodilution or transfusion. Choice of a myocardial preservation solution can be made independently of its effect on intraoperative Hct.
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Del Nido Cardioplegia for Myocardial Protection in Adult Cardiac Surgery: A Systematic Review and Meta-Analysis. ASAIO J 2018; 64:360-367. [DOI: 10.1097/mat.0000000000000652] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Ad N, Holmes SD, Massimiano PS, Rongione AJ, Fornaresio LM, Fitzgerald D. The use of del Nido cardioplegia in adult cardiac surgery: A prospective randomized trial. J Thorac Cardiovasc Surg 2018; 155:1011-1018. [PMID: 29246552 PMCID: PMC5929134 DOI: 10.1016/j.jtcvs.2017.09.146] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The del Nido cardioplegia solution has been used extensively in congenital heart surgery for more than 20 years and more recently for adults. This randomized controlled trial examined whether expanding this technique to adult cardiac surgery confers benefits in surgical workflow and clinical outcome compared with blood-based cardioplegia. METHODS Adult first-time coronary artery bypass grafting (CABG), valve, or CABG/valve surgery patients requiring cardiopulmonary bypass (CPB) were randomized to del Nido cardioplegia (n = 48) or whole blood cardioplegia (n = 41). Primary outcomes assessed myocardial preservation. Troponin I was measured at baseline, 2 hours after CPB termination, 12 and 24 hours after cardiovascular intensive care unit admission. Alpha was set at P < .001. RESULTS Preoperative characteristics were similar between groups, including age, Society of Thoracic Surgeons risk score, CABG, and valve procedures. There was no significant difference on CPB time (97 vs 103 minutes; P = .288) or crossclamp time (70 vs 83 minutes; P = .018). The del Nido group showed higher return to spontaneous rhythm (97.7% vs 81.6%; P = .023) and fewer patients required inotropic support (65.1% vs 84.2%; P = .050), but did not reach statistical significance. Incidence of Society of Thoracic Surgeons-defined morbidity was low, with no strokes, myocardial infarctions, renal failure, or operative deaths. For del Nido group patients, troponin levels did not increase as much as for control patients (P = .040), but statistical significance was not reached. CONCLUSIONS Evidence from this study suggests del Nido cardioplegia use in routine adult cases may be safe, result in comparable clinical outcomes, and streamline surgical workflow. The trend for troponin should be investigated further because it may suggest superior myocardial protection with the del Nido solution.
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Affiliation(s)
- Niv Ad
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa; Adventist HealthCare, Takoma Park, Md; Inova Fairfax Hospital, Falls Church, Va.
| | - Sari D Holmes
- Heart and Vascular Institute, West Virginia University Medicine, Morgantown, WVa
| | | | | | - Lisa M Fornaresio
- Heart and Vascular Institute, West Virginia University Medicine, Morgantown, WVa
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Siddiqi S, Blackstone EH, Bakaeen FG. Bretschneider and del Nido solutions: Are they safe for coronary artery bypass grafting? If so, how should we use them? J Card Surg 2018; 33:229-234. [DOI: 10.1111/jocs.13539] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shirin Siddiqi
- Department of Thoracic and Cardiovascular Surgery; Cleveland Clinic Foundation; Cleveland Ohio
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular Surgery; Heart and Vascular Institute; Cleveland Ohio
- Department of Quantitative Health Sciences; Research Institute; Cleveland Ohio
| | - Faisal G. Bakaeen
- Department of Thoracic and Cardiovascular Surgery; Heart and Vascular Institute; Cleveland Ohio
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Del Nido cardioplegia: A one stop shot for adult cardiac surgery? J Thorac Cardiovasc Surg 2017; 155:1019-1020. [PMID: 29198802 DOI: 10.1016/j.jtcvs.2017.10.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 10/24/2017] [Indexed: 11/23/2022]
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